MEDICAID MGD CARE FOR CHILDREN WITH SPEC HLTH CARE NEEDS

在美国，医疗补助计划注册人数的大幅增加引起了人们对儿童医疗保健服务的担忧，因为这些计划中控制成本的财务激励措施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）。决策者还认识到，转向医疗补助管理的护理可能对患有慢性病或残疾的贫困儿童产生最深远的影响（Fox和McManus，1998年）。另一方面，资本化的管理式护理计划提供了一些优势，如护理管理和服务协调。尽管近年来管理式医疗的广泛发展，但很少有研究探讨管理式医疗安排，特别是资本计划，对特殊医疗需求儿童（SHCN）利用和获得医疗服务的影响。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（由补充保障收入（SSI）的资格确定）。此外，我们将与SHCN儿童的父母进行面谈，以评估获得护理的机会。目前，一些有资格获得SSI的SHCN儿童的父母选择自愿将他们的孩子纳入资本管理式护理计划，而其余的人则选择留在传统的收费服务系统中。从2000年10月起，所有患有SHCN的儿童都必须参加资本管理的护理。父母将有两个资本管理的护理计划之间的选择。本研究的具体目的是：（1）准备详细的个案研究，为管理式护理计划;（2）分析的因素，决定选择一个管理式护理计划的SHCN儿童的父母;（3）评估的影响，计划的选择，儿童健康状况，和其他特征的服务利用的基础上构建的索赔数据的几个指标;（4）对随机抽样的1，200名SHCN儿童的父母进行电话调查，以了解父母难以获得对其子女的照顾的原因;以及（5）开展一项试点研究，向约100名居住在没有儿童看护的家庭中的SHCN儿童的父母了解儿童获得护理的情况，电话。

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.