Preventable hospitalizations among children in California counties after child health insurance expansion initiatives
Preventable hospitalizations among children in California counties after child health insurance expansion initiatives
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DOI：
10.1097/mlr.0b013e3181648640
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发表时间：
2008-02-01
期刊：
影响因子：
3
通讯作者：
Pickering, Trevor A.
中科院分区：
文献类型：
--
作者：
Cousineau, Michael R.;Stevens, Gregory D.;Pickering, Trevor A.
背景：加州将医疗保险扩大到低收入和中等收入家庭的儿童。目前，26个县制定了儿童健康倡议，以补充加州医疗保险和健康家庭计划。然而，随着覆盖范围的扩大，我们对这些项目对儿童健康结果的影响知之甚少。研究设计：儿童住院门诊护理敏感条件（ACSC）是一个广泛采用的衡量健康结果。我们比较了9个CHI县实施CHI之前0 - 18岁儿童的ACSC总住院率与CHI开始运营后的比率。作为比较组，我们按家庭收入水平对分析进行分层，并将低收入家庭的儿童与高收入家庭的儿童进行比较。结果：2000年至2005年间，共有28.1万例可预防的儿科住院病例。在调整了时间和县的影响后，低收入家庭儿童的ACSC住院率比实施前低19%（比率比为0.81,P = 0.0001），但高收入家庭儿童没有这种情况（比率比为0.99,P = 0.93）。我们估计，在实施后，现有的CHI县可能已经避免了6324例ACSC住院，假设每个儿童住院费用为7000美元，在6年内节省了约670万美元。结论：随着健康保险覆盖所有儿童，以及家庭经济上有能力与持续的初级保健来源联系，减少ACSC住院的一些潜在好处可能有助于抵消与确保所有儿童都有保险相关的保费费用。
Background: California has expanded health insurance to children in low- and middle-income families. Currently, Children's Health Initiatives (CHIs) have been developed in 26 counties to supplement Medi-Cal and Healthy Families (SCHIP). Yet, as coverage expands, we know little about the impact of these programs on child health outcomes.Research Design: Child hospitalizations for ambulatory care sensitive conditions (ACSC) is a widely adopted measure of health outcomes. We compare rates of total ACSC hospitalizations among children ages 0 - 18 years in 9 operational CHI counties prior to CHI implementation to rates after the CHIs became operational. As a comparison group, we stratify the analyses by family income level and compare children in lower-income to higher-income families.Results: Between 2000 and 2005, there were 281,000 total preventable hospital pediatric admissions. After adjusting for the effects of time and county, the rate of ACSC hospitalizations was 19% lower postimplementation of CHIs versus preimplementation for children of lower-income families (rate ratio of 0.81, P = 0.0001), but not for children of higher-income families (rate ratio of 0.99, P = 0.93).We estimate that 6324 ACSC hospitalizations may have already been prevented in existing CHI counties after implementation, saving about $6.7 million over the 6 years, assuming $7000 per child hospitalization.Conclusions: With health insurance coverage available for all children, and families financially able to connect with an ongoing source of primary care, some of the potential benefits of reduced ACSC hospitalizations may help to offset premium costs associated with assuring that all children have coverage.