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Liu T, Liu Y, Su Y, Hao J, Liu S. Air pollution and upper respiratory diseases: an examination among medically insured populations in Wuhan, China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:1123-1132. [PMID: 38507092 DOI: 10.1007/s00484-024-02651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
Multiple evidence has supported that air pollution exposure has detrimental effects on the cardiovascular and respiratory systems. However, most investigations focus on the general population, with limited research conducted on medically insured populations. To address this gap, the current research was designed to examine the acute effects of inhalable particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), ground-level ozone (O3), and sulfur dioxide (SO2) on the incidence of upper respiratory tract infections (URTI), utilizing medical insurance data in Wuhan, China. Data on URTI were collected from the China Medical Insurance Basic Database for Wuhan covering the period from 2014 to 2018, while air pollutant data was gathered from ten national monitoring stations situated in Wuhan city. Statistical analysis was performed using generalized additive models for quasi-Poisson distribution with a log link function. The analysis indicated that except for ozone, higher exposure to four other pollutants (NO2, SO2, PM2.5, and PM10) were significantly linked to an elevated risk of URTI, particularly during the previous 0-3 days and previous 0-4 days. Additionally, NO2 and SO2 were found to be positively linked with laryngitis. Furthermore, the effects of air pollutants on the risk of URTI were more pronounced during cold seasons than hot seasons. Notably, females and the employed population were more susceptible to infection than males and non-employed individuals. Our findings gave solid proof of the link between ambient air pollution exposure and the risk of URTI in medically insured populations.
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Affiliation(s)
- Tianyu Liu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yuehua Liu
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing, China
| | - Yaqian Su
- School of Public Health, Shantou University, Shantou, 515063, Guangdong Province, China
| | - Jiayuan Hao
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Suyang Liu
- School of Public Health, Shantou University, Shantou, 515063, Guangdong Province, China.
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Jenkins JM. Healthy and Ready to Learn: Effects of a School-Based Public Health Insurance Outreach Program for Kindergarten-Aged Children. THE JOURNAL OF SCHOOL HEALTH 2018; 88:44-53. [PMID: 29224224 DOI: 10.1111/josh.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/26/2017] [Accepted: 05/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Rates of child insurance coverage have increased due to expansions in public programs, but many eligible children remain uninsured. Uninsured children are less likely to receive preventative care, which leads to poorer health and achievement in the long term. This study is an evaluation of a school-based health insurance outreach initiative, "Healthy and Ready to Learn," aiming to identify and enroll uninsured kindergarteners in areas of high economic need in 16 counties in North Carolina. METHODS Regression discontinuity design and difference-in-differences analyses were used to estimate the effect of the initiative on Medicaid and CHIP enrollment (primary outcome) and preventive care use (well-child visits; secondary outcome). Focus groups and key-informant interviews were conducted to assess best practices and identify barriers to outreach for child enrollment. RESULTS The initiative increased enrollment rates by 12.2% points and increased well-child exam rates by 8.6% points in the RD models, but not differences-in-differences, and did not significantly increase well-child visits. CONCLUSIONS Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low-income parents.
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Affiliation(s)
- Jade Marcus Jenkins
- School of Education, University of California, 3200 Education, Irvine, CA 92697-5500
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Kalverdijk LJ, Bachmann CJ, Aagaard L, Burcu M, Glaeske G, Hoffmann F, Petersen I, Schuiling-Veninga CCM, Wijlaars LP, Zito JM. A multi-national comparison of antipsychotic drug use in children and adolescents, 2005-2012. Child Adolesc Psychiatry Ment Health 2017; 11:55. [PMID: 29046716 PMCID: PMC5637352 DOI: 10.1186/s13034-017-0192-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023] Open
Abstract
Over the last decades, an increase in antipsychotic (AP) prescribing and a shift from first-generation antipsychotics (FGA) to second-generation antipsychotics (SGA) among youth have been reported. However, most AP prescriptions for youth are off-label, and there are worrying long-term safety data in youth. The objective of this study was to assess multinational trends in AP use among children and adolescents. A repeated cross-sectional design was applied to cohorts from varied sources from Denmark, Germany, the Netherlands, the United Kingdom (UK) and the United States (US) for calendar years 2005/2006-2012. The annual prevalence of AP use was assessed, stratified by age group, sex and subclass (FGA/SGA). The prevalence of AP use increased from 0.78 to 1.03% in the Netherlands' data, from 0.26 to 0.48% in the Danish cohort, from 0.23 to 0.32% in the German cohort, and from 0.1 to 0.14% in the UK cohort. In the US cohort, AP use decreased from 0.94 to 0.79%. In the US cohort, nearly all ATP dispensings were for SGA, while among the European cohorts the proportion of SGA dispensings grew to nearly 75% of all AP dispensings. With the exception of the Netherlands, AP use prevalence was highest in 15-19 year-olds. So, from 2005/6 to 2012, AP use prevalence increased in all youth cohorts from European countries and decreased in the US cohort. SGA were favoured in all countries' cohorts.
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Affiliation(s)
- Luuk J. Kalverdijk
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Lise Aagaard
- Life Science Team, IP & Technology, Bech-Bruun Law Firm, Copenhagen, Denmark
| | - Mehmet Burcu
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD USA
| | - Gerd Glaeske
- 0000 0001 2297 4381grid.7704.4Division of Health Long-term Care and Pensions, University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Bremen, Germany
| | - Falk Hoffmann
- 0000 0001 1009 3608grid.5560.6Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Irene Petersen
- 0000000121901201grid.83440.3bDepartment of Primary Care and Population Health, University College London, London, UK
| | | | - Linda P. Wijlaars
- 0000000121901201grid.83440.3bDepartment of Primary Care and Population Health, University College London, London, UK ,0000000121901201grid.83440.3bPopulation, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Julie M. Zito
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD USA
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Bachmann CJ, Wijlaars LP, Kalverdijk LJ, Burcu M, Glaeske G, Schuiling-Veninga CCM, Hoffmann F, Aagaard L, Zito JM. Trends in ADHD medication use in children and adolescents in five western countries, 2005-2012. Eur Neuropsychopharmacol 2017; 27:484-493. [PMID: 28336088 DOI: 10.1016/j.euroneuro.2017.03.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 03/01/2017] [Accepted: 03/05/2017] [Indexed: 01/14/2023]
Abstract
Over the last two decades, the use of ADHD medication in US youth has markedly increased. However, less is known about ADHD medication use among European children and adolescents. A repeated cross-sectional design was applied to national or regional data extracts from Denmark, Germany, the Netherlands, the United Kingdom (UK) and the United States (US) for calendar years 2005/2006-2012. The prevalence of ADHD medication use was assessed, stratified by age and sex. Furthermore, the most commonly prescribed ADHD medications were assessed. ADHD medication use prevalence increased from 1.8% to 3.9% in the Netherlands cohort (relative increase: +111.9%), from 3.3% to 3.7% in the US cohort (+10.7%), from 1.3% to 2.2% in the German cohort (+62.4%), from 0.4% to 1.5% in the Danish cohort (+302.7%), and from 0.3% to 0.5% in the UK cohort (+56.6%). ADHD medication use was highest in 10-14-year olds, peaking in the Netherlands (7.1%) and the US (8.8%). Methylphenidate use predominated in Europe, whereas in the US amphetamines were nearly as common as methylphenidate. Although there was a substantially greater use of ADHD medications in the US cohort, there was a relatively greater increase in ADHD medication use in youth in the four European countries. ADHD medication use patterns in the US differed markedly from those in western European countries.
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Affiliation(s)
| | - Linda P Wijlaars
- Department of Primary Care and Population Health, University College London Medical School, London, United Kingdom; Population, Policy and Practice, University College London Institute of Child Health, London, United Kingdom
| | - Luuk J Kalverdijk
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Mehmet Burcu
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA
| | - Gerd Glaeske
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Germany
| | | | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Germany
| | - Lise Aagaard
- Life Science Team, Bech-Bruun Law Firm, Copenhagen, Denmark
| | - Julie M Zito
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA; Department of Psychiatry, University of Maryland, Baltimore, MD, USA
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Trends and patterns of antidepressant use in children and adolescents from five western countries, 2005-2012. Eur Neuropsychopharmacol 2016; 26:411-9. [PMID: 26970020 DOI: 10.1016/j.euroneuro.2016.02.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 01/15/2016] [Accepted: 02/01/2016] [Indexed: 11/22/2022]
Abstract
Following the FDA black box warning in 2004, substantial reductions in antidepressant (ATD) use were observed within 2 years in children and adolescents in several countries. However, whether these reductions were sustained is not known. The objective of this study was to assess more recent trends in ATD use in youth (0-19 years) for the calendar years 2005/6-2012 using data extracted from regional or national databases of Denmark, Germany, the Netherlands, the United Kingdom (UK), and the United States (US). In a repeated cross-sectional design, the annual prevalence of ATD use was calculated and stratified by age, sex, and according to subclass and specific drug. Across the years, the prevalence of ATD use increased from 1.3% to 1.6% in the US data (+26.1%); 0.7% to 1.1% in the UK data (+54.4%); 0.6% to 1.0% in Denmark data (+60.5%); 0.5% to 0.6% in the Netherlands data (+17.6%); and 0.3% to 0.5% in Germany data (+49.2%). The relative growth was greatest for 15-19 year olds in Denmark, Germany and UK cohorts, and for 10-14 year olds in Netherlands and US cohorts. While SSRIs were the most commonly used ATDs, particularly in Denmark (81.8% of all ATDs), Germany and the UK still displayed notable proportions of tricyclic antidepressant use (23.0% and 19.5%, respectively). Despite the sudden decline in ATD use in the wake of government warnings, this trend did not persist, and by contrast, in recent years, ATD use in children and adolescents has increased substantially in youth cohorts from five Western countries.
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Colby M, Natzke B. Health Care Utilization among Children Enrolled in Medicaid and CHIP via Express Lane Eligibility. Health Serv Res 2015; 50:642-62. [PMID: 25290644 PMCID: PMC4450923 DOI: 10.1111/1475-6773.12241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess health care utilization among children enrolled in Medicaid and CHIP via Express Lane Eligibility (ELE). DATA SOURCES/STUDY SETTING Enrollment, claims, and encounter data for children enrolled in Medicaid or CHIP in Alabama, Iowa, Louisiana, and New Jersey during 2009-2012. STUDY DESIGN We compared health care utilization among children enrolled via ELE and nondisabled children who enrolled through standard pathways in each state. We used a two-step estimation approach, examining the likelihood of utilization and then the volume and cost of services among users. Regression adjustment corrected for demographic differences. PRINCIPAL FINDINGS Most ELE and comparison group children used services within a year of enrollment and accessed a variety of services, including outpatient care, prescription drugs, and dental and vision care. ELE enrollees were somewhat less likely to use each service type, and those who used services often did so less intensively compared to other enrollees in their state. CONCLUSIONS Health care use patterns suggest that ELE enrollees are aware of their coverage; enrollees accessed and repeatedly used services covered by public health insurance. However, states considering this policy may expect that remaining eligible but uninsured children may be less expensive to cover than existing beneficiaries.
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Affiliation(s)
- Margaret Colby
- M.P.P.,1100 1st Street NE, 12th Floor, Washington, DC 20002-4221
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Pearlman SA. The Patient Protection and Affordable Care Act: impact on mental health services demand and provider availability. J Am Psychiatr Nurses Assoc 2013; 19:327-34. [PMID: 24217446 DOI: 10.1177/1078390313511852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Patient Protection and Affordable Care Act (ACA) will greatly increase the demand for mental health (MH) services, as 62.5 million Americans from relatively high-need populations will be newly eligible for MH benefits. Consequently, the supply of MH care provider services is expected to proportionately decrease by 18% to 21% in 2014. ACA funding does not demonstrate the ability to increase turnout of psychiatrists sufficiently to meet the need. Available data indicate that the numbers of advanced practice psychiatric nurses (APPNs) continue to increase at a much greater rate, but information from either a clinical perspective or a market perspective is complicated by the weak distinctions that are made between nurse practitioners (NPs) and other nonphysician care professionals. The following recommendations are made: (a) some of the ACA funding for research into efficient and effective care delivery systems should be allocated to acquiring data on APPNs in leadership roles or clinical settings in which they are ultimately responsible for management of MH care, as differentiated from settings in which they provide support for psychiatrists; and (b) since the available data indicate nurse practitioners achieve good outcomes and are more economically viable than psychiatrists, placement of psychiatric-mental health nurse practitioners in community settings should be recognized as a realistic solution to the shortfall of MH services.
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Abstract
OBJECTIVES Necrotizing soft tissue infections (NSTIs) are uncommon but potentially lethal infections that are well described in adults. Little is known about pediatric patients with NSTI. We sought to examine patients' characteristics, infection characteristics, treatment patterns, and outcomes of children with NSTIs using a large multicenter pediatric database. STUDY DESIGN The Pediatric Health Information System database was used to examine demographics, diagnoses, procedures, medications, hospital charges, and outcomes of pediatric patients with NSTI during a 5-year period. RESULTS A total of 334 patients with NSTI were identified. Times from admission to initial amputations and reconstructive surgeries were similar between the 2 groups, but nonsurvivors had a longer time from admission to their first debridement (median, 2 vs. 1 day, P = 0.03). On multivariate analysis, no other significant risk factors for increased mortality were identified, although increased age (P = 0.10), noncommercial insurance (P = 0.12), and use of corticosteroid therapy (P = 0.06) showed trends toward increased mortality. Diagnoses of streptococcal (P = 0.03) or staphylococcal infection (P = 0.03) were associated with a lower mortality on multivariate analysis. CONCLUSIONS NSTIs are a rare but significant diseases in children. It seems that, as in the adult population, prompt surgical debridement is the most important intervention. Corticosteroid therapy may be associated with a worse prognosis.
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Piper CN, Glover S, Elder K, Baek JD, Wilkinson L. Disparities in access to care among asthmatic children in relation to race and socioeconomic status. J Child Health Care 2010; 14:271-9. [PMID: 20558483 DOI: 10.1177/1367493510371629] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asthma is one of the leading chronic illnesses among children in the United States. International epidemiological studies have also shown asthma prevalence is an increasing problem. The objective of this study was to examine the correlates of access to care among asthmatic children age 0-17 in the United States. This is a retrospective study and secondary data analysis of the 2000 National Health Interview Survey. Parametric testing using univariate, bivariate, and multivariate analyses were performed to examine health care utilization among children with asthma in the United States. It was found that Black children were highly associated with not visiting a general doctor in the past 12 months (OR 0.47; 95% CI 0.30, 0.75). Uninsured asthmatic children were associated with the risk of not seeing a general doctor in the past 12 months (OR 0.40; 95% CI 0.23, 0.69). Our study findings indicate disparities among Black children with asthma and their ability to access appropriate health care services. Additional studies are required to identify factors that contribute to the temporal trends in asthma and country of origin.
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Affiliation(s)
- Crystal N Piper
- Department of Public Health Sciences, University of North Carolina, Charlotte, NC 28223, USA.
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Martin CA, Care M, Rangel EL, Brown RL, Garcia VF, Falcone RA. Severity of head computed tomography scan findings fail to explain racial differences in mortality following child abuse. Am J Surg 2009; 199:210-5. [PMID: 19892316 DOI: 10.1016/j.amjsurg.2009.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 10/15/2008] [Accepted: 05/01/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Differences in head injury severity may not be fully appreciated in child abuse victims. The purpose of this study was to determine if differential findings on initial head computed tomography (CT) scan could explain observed differential outcome by race. METHODS We identified 164 abuse patients from our trauma registry with an Injury Severity Score (ISS) > or = 15. Their initial head CT scan was graded from 1 to 4 (normal to severe). Statistical analysis was performed to asses the correlation between race, head CT grade, Glasgow Coma Scale (GCS) score, and mortality. RESULTS Overall mortality was 17%: 11% for white children, 32% for African-American children (P < .05). In review of the head CT scans there was no difference by race in types of injuries or head CT grade. Using a multivariate regression model, African-American race remained an independent risk factor for mortality with an odd ratio of 4.3 (95% confidence interval [CI] 1.6-11.5). CONCLUSION African-American children had a significantly higher mortality rate despite similar findings on initial head CT scans. Factors other than injury severity may explain these disparate outcomes.
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Affiliation(s)
- Colin A Martin
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
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Arno PS, Sohler N, Viola D, Schechter C. Bringing health and social policy together: the case of the earned income tax credit. J Public Health Policy 2009; 30:198-207. [PMID: 19597453 DOI: 10.1057/jphp.2009.3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The principal objective of our research is to examine whether the earned income tax credit (EITC), a broad-based income support program that has been shown to increase employment and income among poor working families, also improves their health and access to care. A finding that the EITC has a positive impact on the health of the American public may help guide deliberations about its future at the federal, state, and local levels. The authors contend that a better understanding of the relationship between major socioeconomic policies such as the EITC and the public's health will inform the fields of health and social policy in the pursuit of improving population health.
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Affiliation(s)
- Peter S Arno
- Department of Health Policy and Management, School of Public Health, New York Medical College, Valhalla, New York 10595, USA.
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Liao CC, Ganz ML, Jiang H, Chelmow T. The impact of the public insurance expansions on children's use of preventive dental care. Matern Child Health J 2008; 14:58-66. [PMID: 19067137 DOI: 10.1007/s10995-008-0432-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 11/12/2008] [Indexed: 11/26/2022]
Abstract
To determine if children eligible for coverage by the State Children's Health Insurance Program (SCHIP) and Medicaid Programs were more likely to receive preventive dental visits after implementation of the SCHIP policy, retrospective cross-sectional analysis was done from the 1996-2000 Medical Expenditure Panel Surveys (MEPS) data. We linked the individual level data from the MEPS to state-level information on program eligibility. Using logistic regression models that adjust for the complex survey design, the association between SCHIP implementation and receipt of preventive dental care was examined for children aged 3-18 with family incomes < or =200% of the Federal Poverty Line (FPL). Children who were eligible for SCHIP/Medicaid coverage in their respective states were more likely to have received preventive care three years after SCHIP implementation than children with similar eligibility profiles prior to SCHIP implementation. SCHIP has successfully increased the proportion of eligible children receiving preventive dental care among children in families with incomes less than or equal to 200% FPL. Our findings indicate, however, that SCHIP needed time to mature before detecting significant effects on national level.
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Affiliation(s)
- Chi-Chi Liao
- Executive Office of Health and Human Services, The Commonwealth of Massachusetts,OAAC, Boston, MA 02110, USA.
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Endorf FW, Klein MB, Mack CD, Jurkovich GJ, Rivara FP. Necrotizing soft-tissue infections: differences in patients treated at burn centers and non-burn centers. J Burn Care Res 2008; 29:933-8. [PMID: 18997557 PMCID: PMC3042354 DOI: 10.1097/bcr.0b013e31818ba112] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Necrotizing soft-tissue infections (NSTI) are often life-threatening illnesses that may be best treated at specialty care facilities such as burn centers. However, little is known about current treatment patterns nationwide. The purpose of this study was to describe the referral patterns for treatment of NSTI using a multistate discharge database and to investigate the differences in patients with NSTIs treated at burn centers and nonburn centers. The National Inpatient Sample is an all-payer inpatient database from 37 states containing data from 14 million hospital stays each year. We identified all patients with NSTI using International Classification of Disease version 9 codes for necrotizing fasciitis (728.86), gas gangrene (040.0), and Fournier's gangrene (608.83) for the years 2001 and 2004. Patients were dichotomized by location of definitive treatment--either burn centers or nonburn centers. Burn center status was ascertained from the current American Burn Association burn center directory. Patient characteristics, payer status, hospital course, mortality rates, and disposition were compared between patients treated at burn centers and nonburn centers. In 2001 and 2004, a total of 10,940 patients were identified as having a NSTI. The majority (87.1%) of these patients received definitive care at nonburn centers. Patients treated at burn centers were more likely to be transferred from another hospital (OR 2.0, CI 1.8-2.2) and were more likely to have Medicaid (22.6% vs 16.3%, OR 1.39) or be uninsured (18.8% vs 13.7%, OR 1.38). Patients treated at burn centers had more surgical procedures (4.6 vs 4.3, P < .01), and higher hospital charges ($101,800 vs $68,500, P < .01). Total length of stay was also longer at burn centers (22.1 vs 16.0 days, P < .01). Based on a national discharge database, the majority of patients with NSTI are treated at nonburn centers. However, patients treated at burn centers were more likely to be transferred from nonburn centers, had longer lengths of stay, and underwent more operations, all of which are likely attributable to a greater severity of infection.
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Affiliation(s)
- Frederick W Endorf
- Harborview Medical Center and Harborview Injury Prevention Research Center, Seattle, Washington 98104-2499, USA
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A three-country comparison of psychotropic medication prevalence in youth. Child Adolesc Psychiatry Ment Health 2008; 2:26. [PMID: 18817536 PMCID: PMC2569908 DOI: 10.1186/1753-2000-2-26] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 09/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims to compare cross-national prevalence of psychotropic medication use in youth. METHODS A population-based analysis of psychotropic medication use based on administrative claims data for the year 2000 was undertaken for insured enrollees from 3 countries in relation to age group (0-4, 5-9, 10-14, and 15-19), gender, drug subclass pattern and concomitant use. The data include insured youth aged 0-19 in the year 2000 from the Netherlands (n = 110,944), Germany (n = 356,520) and the United States (n = 127,157). RESULTS The annual prevalence of any psychotropic medication in youth was significantly greater in the US (6.7%) than in the Netherlands (2.9%) and in Germany (2.0%). Antidepressant and stimulant prevalence were 3 or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5-2.2 times greater. The atypical antipsychotic subclass represented only 5% of antipsychotic use in Germany, but 48% in the Netherlands and 66% in the US. The less commonly used drugs e.g. alpha agonists, lithium and antiparkinsonian agents generally followed the ranking of US>Dutch>German youth with very rare (less than 0.05%) use in Dutch and German youth. Though rarely used, anxiolytics were twice as common in Dutch as in US and German youth. Prescription hypnotics were half as common as anxiolytics in Dutch and US youth and were very uncommon in German youth. Concomitant drug use applied to 19.2% of US youth which was more than double the Dutch use and three times that of German youth. CONCLUSION Prominent differences in psychotropic medication treatment patterns exist between youth in the US and Western Europe and within Western Europe. Differences in policies regarding direct to consumer drug advertising, government regulatory restrictions, reimbursement policies, diagnostic classification systems, and cultural beliefs regarding the role of medication for emotional and behavioral treatment are likely to account for these differences.
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Fisher MA, Mascarenhas AK. Does Medicaid improve utilization of medical and dental services and health outcomes for Medicaid-eligible children in the United States? Community Dent Oral Epidemiol 2007; 35:263-71. [PMID: 17615013 DOI: 10.1111/j.1600-0528.2007.00341.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Data are lacking to support the contention that Medicaid services improve utilization of healthcare services and result in better health. OBJECTIVE To compare sociodemographic, utilization of healthcare services and health status characteristics among Medicaid-eligible children. METHODS The third National Health and Nutrition Examination Survey included 2821 children 2-16 years of age eligible for Medicaid. The main outcome measures are annual physician visit, annual dentist visit, general health status, oral health status, asthma (second most common childhood disease), dental caries (most common childhood disease), asthma treatment needs, and dental treatment needs. We quantified the association of these outcome measures with Medicaid insurance status and sociodemographic status using multiple logistic regression modeling, taking into account the complex survey design and sample weights. RESULTS Among Medicaid-eligible children, 27% were uninsured. Among uninsured Medicaid-eligible children, 62% had an annual physician visit, 32% had an annual dentist visit, 10% needed asthma treatment, and 57% needed dental treatment. Among insured Medicaid-eligible children, 81% had an annual physician visit, 39% had an annual dentist visit, 13% needed asthma treatment, and 42% needed dental treatment. After simultaneously taking into account other characteristics, uninsured Medicaid-eligible children were more likely to not have an annual physician visit (OR(NoMDvisit) = 2.21; 1.26-3.90), and to need dental treatment (OR(DentalNeed) = 1.57; 1.13-2.18). CONCLUSIONS This USA population-based study found disparities exist within Medicaid's services between utilization of dental and medical services. Medicaid insurance improved utilization of medical services, but did not improve the utilization of dental services. This suggests that Medicaid insurance does not improve access to dental services for poor children.
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Affiliation(s)
- Monica A Fisher
- Case Western Reserve University, Department of Orthodontics, Cleveland, OH 44106-4905, USA.
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16
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Duderstadt KG, Hughes DC, Soobader MJ, Newacheck PW. The impact of public insurance expansions on children's access and use of care. Pediatrics 2006; 118:1676-82. [PMID: 17015561 DOI: 10.1542/peds.2006-0004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to examine the impact of the State Children's Health Insurance Program nationally on children's access and use of health care. OBJECTIVE Our data source was the National Health Interview Survey, using 1997 as a baseline, which predates the implementation of the State Children's Health Insurance Program, and 2003 as the end point of the analysis. We analyzed 25,734 children aged 0 to 18 years (1997 and 2003 combined) to examine changes in health insurance coverage rates, health care access, and utilization for children in the State Children's Health Insurance Program target population, defined here as those living in families with incomes between 100% and 199% of the federal poverty level. RESULTS Children in the State Children's Health Insurance Program target income group showed the largest reduction in rates of uninsurance among 3 income groups (< 100%, 100%-199%, and > or = 200% of the federal poverty level) between 1997 and 2003 (15.1%-8.7%). Significant reductions occurred in the proportion of children without a usual source of care in the target income group (9.4%-7.3%) and in the proportion of children without a provider visit in the past year (10.8%-9.8%). Other measures (unmet needs, delayed care, volume of provider visits, receipt of well-child care, and dental care) showed no significant changes over this time period. A separate multivariate analysis restricted to the State Children's Health Insurance Program target population in 2003 showed that children with continuous public coverage had significantly better access and utilization on all measures studied when compared with uninsured children and performed as well or better than children with continuous private coverage. CONCLUSIONS Implementation of the State Children's Health Insurance Program is associated with substantial gains in public coverage for children in the target income group. Although some of these gains were offset by losses in private coverage, our findings demonstrate that public health insurance provides significant benefits in terms of access and utilization for children living in the target income group.
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Affiliation(s)
- Karen G Duderstadt
- Department of Social and Behavioral Sciences, University of California San Francisco, 3333 California St, Suite 455, San Francisco, CA 94118, USA.
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17
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Stevens GD, Seid M, Halfon N. Enrolling vulnerable, uninsured but eligible children in public health insurance: association with health status and primary care access. Pediatrics 2006; 117:e751-9. [PMID: 16585286 DOI: 10.1542/peds.2005-1558] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Given that more than two thirds of uninsured children in California are eligible for public health insurance coverage, this study examined differences in primary care access and health status between uninsured but eligible (UBE) children and those who were insured. METHODS Using data on 19485 children from the 2001 California Health Interview Survey, this study examined differences in primary care access and health status for UBE children versus those who were enrolled in public coverage. Results are stratified by profiles of other risk factors (RF) for poor access: nonwhite, low income, low parent education, and non-English speaking. RESULTS UBE children were less likely than publicly enrolled children to have a physician visit in the past year, dental visit in the past year, and a regular source of care. On the basis of differences between the UBE children and enrollees in the prevalence of each dependent measure, UBE children with multiple RFs experienced greater disparities than UBE children with fewer RFs. For example, enrollees were more likely than UBE children to have a regular source of care among children with 2, 3, or 4 RFs (differences of 26, 26, and 25 percentage points, respectively) compared with 1 RF (19 percentage points) and 0 RFs (12 percentage points). A similar pattern was found for dental visits but not physician visits. Although there was no difference in health status between UBE children and enrollees overall, enrollees were more likely than UBE children to have excellent/very good health status among children with 2 RFs (difference of 9 percentage points), 3 RFs (12 percentage points), and 4 RFs (11 percentage points). CONCLUSIONS This study demonstrates that UBE children in California have poorer access to care compared with enrollees, and those with the highest levels of risk have poorer health status. This suggests that providing insurance to these children (and particularly those with multiple RFs) may lead to improved access and health for these vulnerable children.
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Affiliation(s)
- Gregory D Stevens
- Division of Community Health, Department of Family Medicine, University of Southern California Keck School of Medicine, Alhambra, CA 91803, USA.
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18
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Zito JM, Tobi H, de Jong-van den Berg LTW, Fegert JM, Safer DJ, Janhsen K, Hansen DG, Gardner JF, Glaeske G. Antidepressant prevalence for youths: a multi-national comparison. Pharmacoepidemiol Drug Saf 2006; 15:793-8. [PMID: 16715536 DOI: 10.1002/pds.1254] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare antidepressant prevalence data in youths across three western European countries (Denmark, Germany, and the Netherlands) with US regional data in terms of age and gender and to show proportional subclass antidepressant (ATD) use. METHOD A population-based analysis of administrative claims data for the year 2000 was undertaken in 0 to 19-year-old enrollees who were part of the insured populations from four countries having a total of from 72,570 to 480,680 members. RESULTS ATD medication utilization in the US dataset (1.63%) exceeded that of three Western European countries (prevalence ranged from 0.11 to 0.54%) by at least 3-fold. There were major variations in the use of subclasses: tricyclic antidepressants (TCAs) predominated in Germany while selective serotonin reuptake inhibitors (SSRIs) predominated in the US, Denmark and the Netherlands. CONCLUSIONS Cross-national variations should be further explored to understand the factors related to these differences and how prevalence differences relate to effectiveness and safety. Community-based cohorts should be followed to establish outcomes in the usual practice setting.
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Affiliation(s)
- Julie M Zito
- University of Maryland, Baltimore, MD 21201, USA.
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Abstract
OBJECTIVE To quantify the number of children who experience gaps in insurance coverage and to determine whether vulnerable subgroups of children experience noteworthy lapses in insurance coverage. METHODS We analyzed nationally representative data from 24,149 children sampled in the 1999-2001 Medical Expenditure Panel Survey linked to the 1997-1999 National Health Interview Survey. Vulnerable subgroups of children included children with chronic conditions, those from ethnic/racial minorities, and those living in poverty. On the basis of cumulative annual monthly insurance coverage status, each child fell into 1 of 3 groups: continuous coverage, uninsured, or gaps in coverage. Using SAS-callable SUDAAN, we conducted multivariate ordinal logistic regression model to quantify the likelihood of having gaps in coverage for vulnerable subgroups of children. RESULTS From 1999 to 2001, we found that >9 million American children annually had gaps in coverage and that 5 to 6 million children annually were uninsured for the entire year. Sixty percent of children experienced gaps of at least 4 months, and >40% of all publicly and privately insured children had coverage gaps. After accounting for relevant covariates, children with chronic conditions were just as likely as other children to have gaps in coverage or be uninsured; Hispanic children were most likely to have insurance gaps or be uninsured; and children from poor and near-poor families were 4 to 5 times more likely to have lapsed coverage than children from high-income families. Poverty and maternal education were the strongest factors associated with lapsed coverage. CONCLUSIONS Unstable health insurance is an underrecognized problem for children, including those with chronic conditions. Because unstable insurance coverage can lead to inadequate health care utilization and poor child health outcomes, strategies to promote stable insurance coverage merit serious consideration.
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Affiliation(s)
- Marlon Satchell
- From the Pediatric Generalist Research Group and Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Susmita Pati
- From the Pediatric Generalist Research Group and Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
- Leonard Davis Institute of Health Economics and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Blumberg SJ, O'Connor KS, Kenney G. Unworried parents of well children: a look at uninsured children who reportedly do not need health insurance. Pediatrics 2005; 116:345-51. [PMID: 16061588 DOI: 10.1542/peds.2004-2085] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We examined the characteristics of uninsured children from low-income households whose parents reported that health insurance coverage was not needed. METHODS With data from the 2001 National Survey of Children With Special Health Care Needs, we used logistic-regression analyses to investigate the odds of reporting that uninsured children do not need insurance for various sociodemographic groups and children of varying health status. We also explored the odds of health care use, awareness of Medicaid and the State Children's Health Insurance Program (SCHIP), and desire to enroll according to the reported need for insurance. RESULTS Parents of 6.8% of uninsured children from low-income households reported that their children did not need insurance. Rates were highest for American Indian/Alaska Native children (15.2%) and children whose parents completed the interview in a non-English language (10.6%). Rates were lowest for children with special health care needs (2.8%) and children with > or =7 school absences attributable to illness or injury in the past year (2.6%). Relative to children with another reason for lacking insurance, children who reportedly did not need insurance were less likely to have needed (adjusted odds ratio: 0.49) or used (adjusted odds ratio: 0.45) health care services in the past year and their parents were less likely to have heard of Medicaid or SCHIP (adjusted odds ratio: 0.58) or to have a desire to enroll their children if their children were eligible for Medicaid or SCHIP (adjusted odds ratio: 0.25). CONCLUSIONS Increasing participation among uninsured children whose parents do not perceive a need for insurance coverage may require more than simply increasing knowledge about the availability of public insurance programs.
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Affiliation(s)
- Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd, Room 2112, Hyattsville, MD 20782, USA.
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21
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Pati S, Keren R, Alessandrini EA, Schwarz DF. Generational differences in U.S. public spending, 1980-2000. Health Aff (Millwood) 2004; 23:131-41. [PMID: 15371377 PMCID: PMC3877927 DOI: 10.1377/hlthaff.23.5.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The balance between spending on children and spending on the elderly is important in evaluating the allocation of public welfare spending. We examine trends in public spending on social welfare programs for children and the elderly during 1980-2000. For both groups, social welfare spending as a percentage of gross domestic product changed little, even during the economic expansions of the 1990s. In constant dollars, the gap in per capita social welfare spending between children and the elderly grew 20 percent. Unlike spending for programs for the elderly, spending for children's programs suffered during recessions. Public discussion about the current imbalance in public spending is needed.
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Lin CJ, Lave JR, Chang CCH, Marsh GM, LaVallee CP, Jovanovic Z. Factors associated with Medicaid enrollment for low-income children in the United States. JOURNAL OF HEALTH & SOCIAL POLICY 2003; 16:35-51. [PMID: 12877247 DOI: 10.1300/j045v16n03_04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study analyzes the 1996-1997 Community Tracking Study Household Survey to identify factors associated with Medicaid enrollment for low-income children and to examine the differences between those enrolled in the Medicaid program and those who were eligible but uninsured. We estimated that 17.4% of Medicaid-eligible children were uninsured. Medicaid eligible children who were younger, African American, with single parents, with AFDC eligible parents, with no parent employed full-time were more likely to be enrolled in the Medicaid program. Children with better health status were less likely to be enrolled in Medicaid. In addition, children whose parents were uninsured were more likely not to be enrolled in Medicaid.
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Affiliation(s)
- Chyongchiou J Lin
- Department of Health Services Administration, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
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23
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Abstract
INTRODUCTION Nationally, 24% of low-income children remain uninsured after the implementation of the State Children's Health Insurance Program (SCHIP). METHOD The purpose of this study was to understand why children remain uninsured by comparing children with insurance to those without it. Using a cross-sectional survey design, 392 low-income parents were interviewed. RESULTS There were distinct profiles for the privately insured, Medicaid-insured and uninsured groups. Statistically significant differences were found across the three groups in income, working status of the adults, education, health status of the adult and child, and in the utilization of health care. Parents of the uninsured children were less knowledgeable about the application process. DISCUSSION Parents of uninsured children face multiple life challenges that may interfere with the enrollment process. Health problems, work schedules, and lack of knowledge may all need to be addressed before we can decrease the number of uninsured children in our nation.
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Nolan L, Zuvekas A, Harvey J, Jones K, Vaquerano LA, Regan J. Enrolling uninsured children in SCHIP. Lessons learned from community health centers. J Ambul Care Manage 2003; 26:51-62. [PMID: 12545515 DOI: 10.1097/00004479-200301000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 1997 Congress established the State Child Health Insurance Program (SCHIP) to address the problem of the nation's low-income uninsured children. To help children become eligible for SCHIP and to tap into the potential revenue stream for previously uninsured children, community health centers have taken differing approaches. This study examines the lessons learned from enrolling children at 14 health centers in six states. The lessons can be valuable for primary care centers and other safety-net providers.
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Affiliation(s)
- Lea Nolan
- Center for Health Services Research and Policy, George Washington University Medical Center, Washington, DC, USA
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American Academy of Pediatrics: Implementation principles and strategies for the State Children's Health Insurance Program. Pediatrics 2001; 107:1214-20. [PMID: 11331712 DOI: 10.1542/peds.107.5.1214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This policy statement presents principles and implementation and evaluation strategies recommended for the State Children's Health Insurance Program (SCHIP). The statement summarizes the current status of SCHIP, the needs of uninsured children, and the potential benefits of SCHIP programs. Principles and recommended strategies include expanding eligibility, maximizing funding, providing comprehensive benefits, including pediatricians in program design and evaluation, providing adequate reimbursement and access to pediatricians, ensuring choices for families and pediatricians, and establishing simple administrative procedures.
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