Health Maintenance Organizations and Children With Special Health Needs

Fox, Harriette B.; Wicks, Lori B.; Newacheck, Paul W.

doi:10.1001/archpedi.1993.02160290052025

Cited by 50 publications

(36 citation statements)

References 4 publications

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“…As Newacheck et al 10 summarize, children with chronic conditions that are activity-limiting tend to use both more acute care services as well as more rehabilitative services. Based on a survey of HMOs, Fox et al 11 suggest that HMOs may offer both advantages (such as comprehensive benefits) and disadvantages (such as referral restrictions) over FFS plans for children with special needs. Our focus on a number of chronic disease conditions for children is, therefore, of interest to various parties concerned with the care of children, including policy-makers, providers, health care organizations, and family advocacy groups.…”

mentioning

confidence: 99%

Health Care Utilization by Children With Chronic Illnesses: A Comparison of Medicaid and Employer-insured Managed Care

Shatin¹,

Levin²,

Ireys

et al. 1998

Pediatrics

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ABSTRACT.Objectives. This study compared utilization of health care services by children with chronic conditions who were insured by either Medicaid or an employer group in 1992 and 1993. Five chronic conditions were selected to illustrate patterns of service use: asthma, attention deficit disorder, diabetes, epilepsy, and sickle cell anemia.Methodology. Administrative databases were used to develop estimates of health services utilization for children <18 years of age with the five selected conditions, who had been enrolled for at least 6 continuous months. All claims for a child identified with one of these five conditions were included in the analysis, including claims for diagnoses and procedures not directly related to the primary diagnosis. Estimates were derived for eight services (eg, hospital admissions, emergency department (ED), home health). Data were used from two Independent Practice Association model health plans in two states. Differences across the states were controlled by selecting one Medicaid and one employer-insured program from each of the two plans in both states. Regional variation was controlled for because both health plans were located in one geographical region. In each case, physicians were paid on a fee-for-service basis, with generally open access to specialists rather than primary care gatekeeper models of delivery: t tests were used to compare service use rates between Medicaid and employer-insured populations.Results. A total of 8668 children across all health plan groups had at least one of the selected conditions. Because Medicaid enrolled-children tended to be younger, analyses were adjusted for age. In both systems, a greater percentage of Medicaid children had these five study conditions (5%) compared with employer-insured children (3%), suggesting that the Medicaid population was sicker. Mean length of enrollment during the 2-year study was longer for children in employer-insured programs. Children with chronic conditions enrolled in Medicaid managed care generally used services at a higher rate compared with children with similar conditions enrolled in employer-insured managed care. The extent of the increased use varied by condition, by service type, and by plan. Children with any of the chronic conditions studied had from 2 to almost 5 times more ED visits if they were enrolled in Medicaid than if they were enrolled in employer-based managed care, depending on the specific condition. In one of the two plans, Medicaidenrolled children had more outpatient services, laboratory services, and radiography services than their counterparts in employer-based managed care. The same pattern of use was found for home health services (except for children with diabetes) and for office visits (except for children with sickle cell). The results show higher use of all services by children with asthma and diabetes in Medicaid managed care compared with employer-based managed care. In contrast, the pattern is mixed for children with epilepsy and sickle cell. The sample size of children w...

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mentioning

confidence: 99%

Health Care Utilization by Children With Chronic Illnesses: A Comparison of Medicaid and Employer-insured Managed Care

Shatin¹,

Levin²,

Ireys

et al. 1998

Pediatrics

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“…Paediatric outpatient rehabilitation services for children under 6 years of age were no longer provided at acute care paediatric hospitals; children requiring these services were referred to specialized paediatric rehabilitation centres. This situation created accessibility problems (Régie régionale de la santé et des services sociaux (Fox et al 1993;Majnemer et al 2002;Feldman et al 2002;Simpson et al 2003).…”

Section: Résumémentioning

confidence: 99%

“…For example, children may be denied access to rehabilitation services provided by Health Maintenance Organizations (HMOs) if the child cannot improve significantly over a short period of time, which is often the case for children with severe disabilities (Fox et al 1993). In other cases, the more severe a physician perceives a child' s disability, the more likely it is that the child will be referred to physical therapy (Campbell et al 1995).…”

Section: Résumémentioning

confidence: 99%

Wait Times for Paediatric Rehabilitation

Grilli¹,

Feldman²,

Swaine³

et al. 2007

hcpol

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Background: Early therapy intervention for children with disabilities may improve functional outcomes. Access to paediatric rehabilitation services can sometimes be difficult. Objectives: To describe waiting time to receive physical therapy (PT) and occupational therapy (OT) services at rehabilitation centres for young children with physical disabilities; to examine factors associated with these waiting times. Design: Prospective cohort. Subjects: Two hundred and six children with physical disabilities, aged 6 to 72 months, referred in 2002-2004 from the Montreal Children' s Hospital and Sainte-Justine Hospital to paediatric rehabilitation centres. Measures: Data on date of referral, age, gender and diagnosis were obtained from the hospital databases. Data on date of first PT or OT appointments at the rehabilitation centre, family socio-demographics and disability severity (WeeFIM) were obtained during parental interviews. Results: Half of the sample waited more than 7 and 11 months for PT and OT services, respectively. Shorter waiting time was significantly associated with younger child' s age and referral to one particular rehabilitation centre. Conclusion: Children with physical disabilities experience long waiting times for PT and OT rehabilitation services. Strategies to improve timely service delivery are needed.

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“…The total length of stay and time to arrange home care funding was significantly longer for children funded by public agencies than for those covered by private insurance. Fox, Wicks, and Newacheck (1993) found that health maintenance organizations (HMOs) offer several advantages over traditional feefor-service plans for families whose children have special health needs. HMOs were more likely to cover ancillary therapies, home care, outpatient mental health care, and medical case management (Fox et al, 1993).…”

Section: Societal Factorsmentioning

confidence: 99%

Extended Hospitalization of Medically Stable Children Dependent on Technology: A Focus on Mutable Family Factors

Cross

Leonard

Skay

et al. 1998

Issues in Comprehensive Pediatric Nursing

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This study identified three factors that influenced extended hospital stay in medically stable children dependent on medical technology. A retrospective review of 50 charts in a level II nursery was conducted. Bivariate analysis identified factors contributing to extended stay: parental factors, societal factors, health care factors, and presence of disease. Multiple regression explained 98% of the variance in extended length of stay. Family factors accounted for 19.6%, nonfamily factors accounted for 42.5%, and the two sets of factors together accounted for an additional 35.9%. Family-related issues with a high potential for change were identified. Pediatric providers should develop family intervention strategies that identify the most appropriate level of care that both advocates in the best interest of the child and family and contains the rising cost of health care.

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Health Maintenance Organizations and Children With Special Health Needs

Cited by 50 publications

References 4 publications

Health Care Utilization by Children With Chronic Illnesses: A Comparison of Medicaid and Employer-insured Managed Care

Health Care Utilization by Children With Chronic Illnesses: A Comparison of Medicaid and Employer-insured Managed Care

Wait Times for Paediatric Rehabilitation

Extended Hospitalization of Medically Stable Children Dependent on Technology: A Focus on Mutable Family Factors

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