MEDICAID CHANGES--IMPACT ON AT RISK CHILDREN

医疗补助变更——对高危儿童的影响

• 批准号: 2653459
• 负责人: Laurel K. Leslie
• 金额: $ 3.93万
• 依托单位: RADY CHILDREN'S HOSPITAL - SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-09-30 至 1999-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2653459
• 关键词: Medicare /Medicaid; behavioral /social science research tag; child (0-11); child abuse; clinical research; disease /disorder proneness /risk; family structure /dynamics; health care policy; health care quality; health care service evaluation; health care service utilization; health services research tag; home health care; human population study; human subject; managed care; socioeconomics

Many states are in the process of shifting their Medicaid programs from a free-for-service (FFS) payment structure to capitated managed care. California, whose Medicaid population in 1996 represented 16.3% of the total national Medicaid population, has embarked on an initiative to move 3.2 million Medicaid recipients, 75% of whom are children, into managed care plans over the next few years. Implementation of mandatory Medicaid managed care may significantly affect the provision of primary care services to children. Home visitation services have been shown to improve access to care and appropriate use of services for children at risk for child abuse and neglect. This study aims to: 1) track the enrollment process into one of six plans participating in mandatory Medicaid managed care in San Diego Country for a cohort of families at risk for child abuse and neglect, 2) investigate the effect of enrollment into mandatory Medicaid managed care on access to, continuity with, and use of primary care services for young children in at risk families, 3) examine how managed care enrollment interfaces with other factors associated with use of primary care services, and 4) assess whether home visitation services provide a protective effect for children in at risk families with regard to access to health care. The sample includes 448 mothers and their infants, identified at delivery as at risk for child abuse and neglect, participating in a randomized clinical trial of home visitation services in San Diego County. Data will be collected from families at four month intervals and cross- referenced with County welfare and Medicaid data sets. The impact of the enrollment process and home visitation services on primary care services will be assessed within the context of a comprehensive multivariate model of sociodemographic, familial and organizational factors based on the Andersen and Aday access model. Dependent variables include regular sources of primary care, use of alternative sites of care, well-visits, sick visits based on site of care, and compliance with AAP recommendations for well-visits and immunization rates. Long-term objectives are to provide information to better guide health policy with respect to mandatory Medicaid managed care enrollment and the provision of primary care services for vulnerable children in poor, at risk families.

许多州正在改变其医疗补助计划 从免费服务（FFS）支付结构到资本管理 在乎 加州，其1996年的医疗补助人口 全国医疗补助总人口的16.3%，已经开始实施 该计划将320万名医疗补助受助人转移到其他地区，其中75%是 在未来的几年里，将儿童纳入管理式护理计划。 实施强制性医疗补助管理式护理可能 严重影响向儿童提供初级保健服务。 家访服务已被证明可以改善获得护理的机会 和适当利用为有可能遭受虐待的儿童提供的服务 和忽视 本研究旨在：1）跟踪招生过程， 参与强制性医疗补助管理医疗的六个计划之一， 圣地亚哥国家为一组有虐待儿童风险的家庭 2）调查强制入学的效果 医疗补助管理式护理的获取、连续性和使用 为处境危险家庭的幼儿提供初级保健服务，3） 检查管理式护理登记如何与其他因素相互作用 与使用初级保健服务有关，以及4）评估是否 家访服务为在孤儿院的儿童提供了保护作用， 在获得医疗保健方面存在风险的家庭。 样品 包括448名母亲及其婴儿， 儿童虐待和忽视的风险，参加一个随机 圣地亚哥县家访服务的临床试验。 数据 每隔四个月从家庭收集一次， 参考县福利和医疗补助数据集。的影响 小学入学程序及家访服务 护理服务将在一个全面的背景下进行评估， 社会人口、家庭和组织的多变量模型 基于Andersen和Aday访问模型的因素。 依赖 变量包括初级保健的常规来源、替代医疗服务的使用、 护理地点、井访、基于护理地点的病假，以及 遵守AAP的油井访视建议， 免疫率。 长期目标是提供信息 在强制性医疗补助方面更好地指导卫生政策 管理式护理登记和提供初级保健服务 为贫困和危险家庭中的弱势儿童提供帮助。