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Chung EK, Short VL, Hand DJ, Gubernick RS, Abatemarco DJ. Poor prenatal care does not predict well child care for children born to mothers with opioid use disorder. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1736665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Esther K. Chung
- Department of Pediatrics, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, The A.I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Vanessa L. Short
- Department of Obstetrics and Gynecology, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dennis J. Hand
- Department of Obstetrics and Gynecology, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ruth S. Gubernick
- Quality Improvement Advisor, RSG Consulting, Collingswood, New Jersey, USA
| | - Diane J. Abatemarco
- Department of Obstetrics and Gynecology, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Adams EK, Johnston EM, Guy G, Joski P, Ketsche P. Children's Health Insurance Program Expansions: What Works for Families? Glob Pediatr Health 2019; 6:2333794X19840361. [PMID: 31065575 PMCID: PMC6487762 DOI: 10.1177/2333794x19840361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 11/26/2022] Open
Abstract
We examine the impact of Children’s Health Insurance Program (CHIP) eligibility expansions 1999 to 2012 on child and joint parent/child insurance coverage. We use changes in state CHIP income eligibility levels and data from the Current Population Survey Annual Social and Economic Supplement to create child/parent dyads. We use logistic regression to estimate marginal effects of eligibility expansions on coverage in families with incomes below 300% federal poverty level (FPL) and, in turn, 150% to 300% FPL. The latter is the income range most expansions targeted. We find CHIP expansions increased public coverage among children in families 150% to 300% FPL by 2.5 percentage points (pp). We find increased joint parent/child coverage of 2.3 pp (P = .055) but only in states where the public eligibility levels for parent and child are within 50 pp. In these states, the CHIP expansion increased the probability that both parent/child are publicly insured (2.5 pp) among insured dyads, but where the eligibility levels are further apart (51-150 pp; >150 pp), CHIP expansions increase the probability of mixed coverage—one public, one private—by 0.9 to 1.5 pp. Overall, families made decisions regarding coverage that put the child first but parents took advantage of joint parent/child coverage when eligibility levels were close. Joint public parent/child coverage can have positive care-seeking effects as well as reduced financial burdens for low-income families.
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Affiliation(s)
| | | | - Gery Guy
- Emory University, Atlanta, GA, USA
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Engelgau MM, Zhang P, Jan S, Mahal A. Economic Dimensions of Health Inequities: The Role of Implementation Research. Ethn Dis 2019; 29:103-112. [PMID: 30906157 DOI: 10.18865/ed.29.s1.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Health inequities are well-documented, but their economic dimensions have received less attention. In this report, we describe four economic dimensions of health inequities in the United States. First, we describe an economic conceptual framework that connects poverty and health inequities at both individual and population levels and conveys the concept of reverse causality, where poverty worsens health inequities and health inequities worsen poverty. This framework can help us understand the key elements of health inequity and its drivers. Second, we describe economic measurements used for quantifying the economic burden of health inequalities and summarize the empirical findings from studies. Third, we review the evidence on the return-on-investment of economic interventions that are aimed at reducing health inequities. Finally, we highlight the importance of cross disciplinary perspectives from economics and implementation research in effectively delivering interventions that can mitigate health inequities.
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Affiliation(s)
- Michael M Engelgau
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Ping Zhang
- National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
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Nguyen J, Anandasivam NS, Cooperman D, Pelker R, Wiznia DH. Does Medicaid Insurance Provide Sufficient Access to Pediatric Orthopedic Care Under the Affordable Care Act? Glob Pediatr Health 2019; 6:2333794X19831299. [PMID: 30815517 PMCID: PMC6381430 DOI: 10.1177/2333794x19831299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 11/16/2022] Open
Abstract
The Patient Protection and Affordable Care Act had a profound impact on health insurance coverage of children. Given the importance of pediatric specialty care, this study assessed access to pediatric orthopedic urgent care for a child’s likely operative distal radius fracture. Researchers called 180 pediatric orthopedic surgeons in 8 states requesting appointments for the caller’s fictitious 11-year-old child who suffered a distal radius fracture. Each office was called twice to assess the ability to obtain an appointment for Medicaid and privately insured patients. Overall, significantly fewer offices scheduled appointments for Medicaid than privately insured patients (38.3% vs 82.8%, P < .001). Patients with Medicaid in states without Medicaid expansion were more successful in obtaining appointments than patients with Medicaid in states with Medicaid expansion (41 [47%] vs 28 [30%]; P < .001; 95% confidence interval = 0.3-0.9). Pediatric Medicaid patients experienced reduced access to care, and this access was worse in states that had expanded Medicaid eligibility.
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Bergmark RW, Ishman SL, Phillips KM, Cunningham MJ, Sedaghat AR. Emergency department use for acute rhinosinusitis: Insurance dependent for children and adults. Laryngoscope 2017; 128:299-303. [PMID: 28730629 DOI: 10.1002/lary.26671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/14/2017] [Accepted: 04/11/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patients with Medicaid or self-pay insurance status are more likely to present to the emergency department (ED) for uncomplicated acute rhinosinusitis (ARS). Our aim was to determine if this pattern holds true for both pediatric and adult visits. STUDY DESIGN Cross-sectional study using the 2005 to 2012 National Hospital Ambulatory Medical Care Surveys and National Ambulatory Medical Care Surveys. METHODS We included all visits with International Classification of Diseases, Ninth Revision codes for ARS and without codes for ARS complications. We tested for associations between insurance type and presentation to an ED versus a primary care physician (PCP), stratifying children versus adults. We used univariate and multivariable logistic regression modeling, controlling for clinical and demographic characteristics for analysis. RESULTS There were 51,579,977 uncomplicated ARS visits to PCPs (48,213,335 visits) and EDs (3,366,642 visits). Medicaid and uninsured patients were under-represented for ARS visits. Medicaid insurance was significantly associated with ED presentation for ARS for both children (adjusted odds ratio [OR] = 7.0, P < 0.001) and adults (adjusted OR = 6.8, P < 0.001). Children with ARS and self-pay insurance status were much more likely to present to the ED (adjusted OR = 48.8, P < 0.001) than adults (adjusted OR = 5.2, P < 0.001); this difference between children and adults with self-pay insurance was significant (P = 0.001). CONCLUSION With respect to absolute numbers of visits, patients with Medicaid or no insurance use less care overall for uncomplicated ARS than do privately insured patients. Medicaid is associated with ED presentation for ARS for pediatric and adult visits. Self-pay insurance status is strongly associated with ED presentation for adult and pediatric visits, and is significantly more common for children. These results suggest limitations in primary care access for uncomplicated ARS based on insurance status, particularly for uninsured pediatric patients. LEVEL OF EVIDENCE 4. Laryngoscope, 128:299-303, 2018.
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Affiliation(s)
- Regan W Bergmark
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Stacey L Ishman
- Division of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katie M Phillips
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Michael J Cunningham
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Wong CA, Kan K, Cidav Z, Nathenson R, Polsky D. Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans. Pediatrics 2017; 139:peds.2016-3117. [PMID: 28250022 DOI: 10.1542/peds.2016-3117] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe and compare pediatric and adult specialty physician networks in marketplace plans. METHODS Data on physician networks, including physician specialty and address, in all 2014 individual marketplace silver plans were aggregated. Networks were quantified as the fraction of providers in the underlying rating area within a state that participated in the network. Narrow networks included none available networks (ie, no providers available in the underlying area) and limited networks (ie, included <10% of the available providers in the underlying area). Proportions of narrow networks between pediatric and adult specialty providers were compared. RESULTS Among the 1836 unique silver plan networks, the proportions of narrow networks were greater for pediatric (65.9%) than adult specialty (34.9%) networks (P < .001 for all specialties). Specialties with the highest proportion of narrow networks for children were infectious disease (77.4%) and nephrology (74.0%), and they were highest for adults in psychiatry (49.8%) and endocrinology (40.8%). A larger proportion of pediatric networks (43.8%) had no available specialists in the underlying area when compared with adult networks (10.4%) (P < .001 for all specialties). Among networks with available specialists in the underlying area, a higher proportion of pediatric (39.3%) than adult (27.3%) specialist networks were limited (P < .001 except psychiatry). CONCLUSIONS Narrow networks were more prevalent among pediatric than adult specialists, because of both the sparseness of pediatric specialists and their exclusion from networks. Understanding narrow networks and marketplace network adequacy standards is a necessary beginning to monitor access to care for children and families.
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Affiliation(s)
- Charlene A Wong
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia.,Leonard Davis Institute of Health Economics, and
| | - Kristin Kan
- Robert Wood Johnson Foundation Clinical Scholars Program and .,Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | - Zuleyha Cidav
- Leonard Davis Institute of Health Economics, and.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Zickafoose JS, Smith KV, Dye C. Children with Special Health Care Needs in CHIP: Access, Use, and Child and Family Outcomes. Acad Pediatr 2015; 15:S85-92. [PMID: 25906964 DOI: 10.1016/j.acap.2015.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess how the Children's Health Insurance Program (CHIP) affects outcomes for children with special health care needs (CSHCN). METHODS We used data from a survey of parents of recent and established CHIP enrollees conducted from January 2012 through March 2013 as part of a congressionally mandated evaluation of CHIP. We identified CSHCN in the sample using the Child and Adolescent Health Measurement Initiative's CSHCN screener. We compared the health care experiences of established CHIP enrollees to the pre-enrollment experiences of previously uninsured and privately insured recent CHIP enrollees, controlling for observable characteristics. RESULTS Parents of 4142 recent enrollees and 5518 established enrollees responded to the survey (response rates, 46% recent enrollees and 51% established enrollees). In the 10 survey states, about one-fourth of CHIP enrollees had a special health care need. Compared to being uninsured, parents of CSHCN who were established CHIP enrollees reported greater access to and use of medical and dental care, less difficulty meeting their child's health care needs, fewer unmet needs, and better dental health status for their child. Compared to having private insurance, parents of CSHCN who were established CHIP enrollees reported similar levels of access to and use of medical and dental care and unmet needs, and less difficulty meeting their child's health care needs. CONCLUSIONS CHIP has significant benefits for eligible CSHCN and their families compared to being uninsured and appears to have some benefits compared to private insurance.
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Affiliation(s)
| | | | - Claire Dye
- Mathematica Policy Research, Princeton, NJ
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