MEDICAID MGD CARE FOR CHILDREN WITH SPEC HLTH CARE NEEDS

针对有 SPEC HLTH 护理需求的儿童的 MEDICAID MGD 护理

• 批准号: 6592857
• 负责人: Jean M Mitchell
• 金额: $ 7.19万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-06-01 至 2004-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6592857
• 关键词: Medicare /Medicaid; child (0-11); health care service evaluation; health care service utilization; health science research analysis /evaluation; human subject; interview; managed care; medically underserved population; pediatrics; urban poverty area

The substantial increase in Medicaid enrollment in capitated plans has raised a number of concerns regarding the delivery of child health care in the U.S. because the financial incentives to control costs inherent in such plans may elicit under-treatment and restrict access to specific treatments, services and specialty providers (Hughes and Luft, 1998). Policymakers also recognize that the shift to Medicaid managed care is likely to have the most profound impact on poor children with chronic or disabling conditions (Fox and McManus, 1998). On the other hand, capitated managed care plans offer several advantages such as care management and coordination of services. Despite the widespread growth of managed care in recent years, little research has examined the effects of managed care arrangements, in particular capitated plans, on utilization of and access to health care services by children with special health care needs (SHCN). We propose to analyze Medicaid eligibility, claims and encounter data for children with SHCN (as determined by eligibility for Supplemental Security Income (SSI)) enrolled in the DC Medicaid program. In addition, we will conduct interviews with parents of children with SHCN to evaluate access to care. Currently, some parents of children with SHCN who qualify for SSI have chosen to voluntarily enroll their child in the capitated managed care plan, while the remainder have opted to remain in the traditional fee-for-service system. As of October 2000, enrollment in capitated managed care will be mandatory for all children with SHCN. Parents will have a choice between two capitated managed care plans. The specific aims of this study are: (1) to prepare detailed case studies for the managed care plans; (2) to analyze factors determining selection of a managed care plan by the parents of children with SHCN; (3) to evaluate the effect of plan choice, child health status, and other characteristics on utilization of services based on several indicators constructed from claims data; (4) to conduct a telephone survey with a random sample of 1,200 parents of children with SHCN to elicit information on why parents have difficulties obtaining access to care for their children; and (5) to conduct a pilot study to obtain information on children's access to care from about 100 parents of children with SHCN who reside in households without telephones.

联邦医疗补助计划注册人数的大幅增加引起了人们对美国儿童保健服务的关注，因为控制此类计划固有成本的财政激励可能会导致治疗不足，并限制获得特定治疗、服务和专业提供者（Hughes和Luft， 1998）。政策制定者也认识到，向医疗补助管理式医疗的转变可能会对患有慢性或致残疾病的贫困儿童产生最深远的影响（Fox和McManus， 1998）。另一方面，资本管理式护理计划提供了一些优势，如护理管理和服务协调。尽管近年来管理式护理得到了广泛的发展，但很少有研究审查管理式护理安排，特别是固定资本计划，对有特殊保健需要的儿童利用和获得保健服务的影响。我们建议分析参加DC医疗补助计划的SHCN儿童的医疗补助资格、索赔和遭遇数据（由补充安全收入（SSI）的资格决定）。此外，我们将与患有SHCN儿童的父母进行访谈，以评估获得护理的机会。目前，一些符合SSI资格的SHCN儿童的父母选择自愿将他们的孩子登记在有资本管理的护理计划中，而其余的人则选择继续使用传统的收费服务系统。自2000年10月起，所有患有SHCN的儿童都必须参加有资格管理的医疗服务。父母可以在两种有资本的管理式医疗计划中选择。本研究的具体目的是：(1)为管理式医疗计划准备详细的案例研究；(2)分析影响SHCN患儿家长选择管理式护理计划的因素；(3)基于索赔数据构建的多个指标，评估计划选择、儿童健康状况和其他特征对服务利用的影响；(4)随机抽取1200名患有严重神经缺陷儿童的家长进行电话调查，以了解家长为何难以获得照顾子女的机会；(5)进行一项试点研究，向约100名居住在没有电话的家庭中患有严重残疾儿童的父母了解儿童获得照顾的情况。