MEDICAID MGD CARE FOR CHILDREN WITH SPEC HLTH CARE NEEDS

医疗补助计划的大幅增加引起了人们对美国儿童保健服务的关注，因为控制此类计划中固有成本的财政激励措施可能会导致治疗不足，并限制获得特定治疗、服务和专科提供者的机会(Hughes和Luft，1998)。政策制定者还认识到，向医疗补助管理保健的转变可能会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)。另一方面，资助式管理型医疗计划提供了几个优势，如医疗管理和服务协调。尽管管理保健近年来得到了广泛的发展，但很少有研究研究管理保健安排，特别是头衔计划对有特殊卫生保健需要的儿童(SHCN)利用和获得卫生保健服务的影响。我们建议分析参加DC医疗补助计划的SHCN儿童(由补充保障收入(SSI)的资格决定)的医疗补助资格、申领和遭遇数据。此外，我们将与患有小儿麻痹症儿童的父母进行访谈，以评估获得护理的机会。目前，一些有资格参加SSI的SHCN儿童的父母选择自愿将他们的孩子登记在资助式托管照顾计划中，而其余的则选择继续使用传统的按服务收费制度。从2000年10月起，所有患有SHCN的儿童都将强制参加大写管理型护理。家长将可以在两个首肯的管理型护理计划之间进行选择。这项研究的具体目的是：(1)为管理型护理计划准备详细的案例研究；(2)分析决定SHCN儿童父母选择管理型护理计划的因素；(3)基于索赔数据构建的几个指标，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)对1,200名SHCN儿童的父母进行随机电话调查，以了解为什么父母难以获得照顾他们的孩子的信息；以及(5)进行一项试验性研究，从居住在没有电话的家庭中的约100名患有慢性病儿童的父母那里获得有关儿童获得照顾的信息。

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.