The Safety Net, Medicaid, and Child Health Outcomes

描述（由申请人提供）：2003年，没有医疗保险的儿童比例为11.4%，比1987年的12.9%有所下降，但尽管在此期间医疗补助覆盖范围大幅扩大，并引入了国家儿童健康保险计划（SCHIP），但仍然居高不下：符合公共保险条件的儿童比例从1987年的17.8%上升到2000年的41.7%。最近，从1998年开始的十年内，划拨了400亿美元的联邦配套基金，用于资助SCHIP的扩展。没有保险的人被迫严重依赖“安全网”提供者来满足他们的医疗保健需求。大多数社区的卫生保健安全网由各种卫生保健提供者拼凑而成，其中包括公立医院、教学医院、社区诊所和地方卫生部门等。布什政府提出的5年7.8亿美元保健中心倡议强调了安全网提供者的重要性，该倡议将使保健中心到2006财政年度结束时能够再为610万病人提供服务。虽然有许多研究调查了没有保险和保险不足的人如何影响医疗保健安全网，但相对较少的研究调查了相反的情况：医疗保健安全网如何影响使用它的人的健康。同样，虽然许多研究试图将医疗补助计划的扩大与儿童健康结果联系起来，但很少有研究试图将卫生保健安全网的特征和方面与儿童健康结果联系起来。本申请建议使用国家数据来检查通过卫生保健安全网提供护理如何影响儿童的健康结果。此外，本研究要解决的一个相关目标是，就边际美元对儿童健康的影响而言，确定边际美元最有效地用于何处：用于提高公共保险资格，或用于通过保健安全网直接资助或补贴提供贫困护理。最后一个研究领域将审查保健安全网与儿童健康结果之间的关系如何因种族和族裔而异。

DESCRIPTION (provided by applicant): The percentage of children without health insurance was 11.4% in 2003, which is down from 12.9% in 1987, but nonetheless stubbornly high despite the large expansions during this period in Medicaid coverage and the introduction of the State Children's Health Insurance Program (SCHIP): the percentage of children eligible for public insurance rose from 17.8% in 1987 to 41.7% in 2000. Most recently, $40 billion in federal matching funds were allocated over ten years beginning in 1998 to fund the SCHIP expansions. The uninsured are forced to depend heavily on "safety net" providers to meet their health care needs. The health care safety net in most communities is made up of a patchwork of health care providers that include public hospitals, teaching hospitals, community-based clinics, and local health departments among others. The importance of safety net providers has been highlighted by the Bush Administration's proposed five-year $780 million Initiative for Health Centers that would enable the health centers to reach an additional 6.1 million patients by the end of Fiscal Year 2006. While there are numerous studies examining how the uninsured and underinsured affect the health care safety net, comparatively little research has examined the converse: how the health care safety net affects the health of those who use it. Similarly, while a number of studies have attempted to relate Medicaid expansions to child health outcomes, few studies have attempted to relate characteristics and aspects of the health care safety net to children's health outcomes. This application proposes to use national data to examine how the provision of care through the health care safety net affects health outcomes for children. In addition, a related aim to be addressed in this study to determine where marginal dollars are most effectively spent in terms of their impact on child health: on increasing public insurance eligibility or on directly funding or subsidizing the provision of indigent care by the health care safety net. A final area of study will examine how the relationship between the health care safety net and children's health outcomes differs by race and ethnicity.