Health Insurance is a Family Matter (2002) / Chapter Skim
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Appendix C: Research Review: Health Care Access, Utilization, and Outcomes for Children, Pregnant Women, and Infants
Appendix C: Research Review: Health Care Access, Utilization, and Outcomes for Children, Pregnant Women, and Infants
Pages 161-212
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From page 161... ...
Research Review: Health Care Access, Utilization, and Outcomes for Children, Pregnant Women, and Infants' 1 this appendix provides brief synopses of the studies that were reviewed for and presented in Chapter 6. The table is organized according to the four major sections in Chapter 6: "Access to and Use of Health Care by Children," "Health Outcomes for Children and Youth," "Effect of Health on Children's Life Chances," and "Prenatal and Perinatal Care and Outcomes," Studies are listed alphabetically within each section.
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From page 162... ...
Medical Care Data from the NHIS Child Health (CH) Supplement, 1 998 Data from 1988 NHIS, Child Health Supplement; 9.6 million U
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From page 163... ...
Black and Hispanic children were two times as likely to be uninsured. The proportion of uninsured children who had seen a physician was lower than the proportion of those with private insurance.
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From page 164... ...
Pediatrics Currie and Duncan (1995) Medical Care for Children: Public Insurance, Private Insurance, and Racial Differences in Utilization.
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From page 165... ...
Parents of SCHIP children are disproportionately self-employed or in industries and occupations in which health insurance coverage is less available or affordable. Compared to privately insured children, SCHIPeligible children are three times more likely to be Hispanic and nearly two times more likely to be rated in fair or poor health.
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From page 166... ...
(1995) Profile of Uninsured Children in the United States.
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From page 167... ...
The subsequent deterioration in the health of children from immigrant families the longer they reside in the United States suggests that with assimilation into American culture the protective aspects of immigrant culture diminish, allowing the harmful effects of low socioeconomic status, high poverty, and racial or ethnic stratification to emerge. Residence in the South (OR = 2.3)
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From page 168... ...
N Engl J Med Data for 887 families of newly enrolled children in 29 counties of western Pennsylvania Data on 7,465 10 - 17-yearolds included in the Child Health Supplement to the Data on insurance coverage, utilization, and expenditures from MEPS.
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From page 169... ...
Uninsured children were less likely to have a usual source of care (adj.
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From page 170... ...
. vision care Assess health insurance status, trends in health care coverage, demographic and socioeconomic correlates of coverage, and role of insurance in influencing use of and access to care Characteristics of special needs children such as health status, access to care, satisfaction, and demographics Resul minor group than c in ant usual CI = group the p< CI = emer' CI = Thes (OR minor more the pi for th (OR minor Of ch condo to ha, poor as lilts The ~ childr unme childr In 19 highe paren 95.6°~ durin adore!
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From page 171... ...
. Between 1984 and 1995 the percentage of adolescents with some sort of insurance remained unchanged; however those with private insurance decreased and those with public insurance increased.
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From page 172... ...
(1994) Health Insurance Status and Ambulatory Care for Children.
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From page 173... ...
Socioeconomic characteristics were related to insurance coverage: 16.7% of those <100% FPL were uninsured, while 18.1% of those 100-199% FPL were uninsured, and 4.1% of those 2200% FPL were uninsured. Uninsured children were less likely to have a usual source of care (adj.
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From page 174... ...
Does Public Insurance Increase the Efficiency of Medical Care? Medicaid Expansions and Child Hospitalizations q NHDS data for four age groups: <1, 1-5, 6-10, and 11-15, 1983-1996 To measure the association between CHP and access to care, utilization of care, quality of care, and health care costs Access to care, utilization of care, and quality measures Access to care, use of care, and perceived health status Usual source of care Usual source of care; the probability of having at least one ambulatory care visit; and the average number of visits for those who have used any ambulatory care services Avoidable hospitalizations for children < 16 Utili2 associ care.
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From page 175... ...
Over 1983-1996, child hospitalizations increased by 10% due to Medicaid expansions. Avoidable hospitalizations fell 22% due to Medicaid eligibility expansions.
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From page 176... ...
. injury severity Number of acute illness episodes; bed days; school loss days; restricted activity days reported for two-week period before interview Clinician-reported items: insurance status, clinician identification of a psychosocial problem, visit characteristics; parent- or guardian-reported items: psychosocial problems, family functioning Rate of appendiceal perforation Result expans very 1` some areas ( (from Coarct insurai more ]
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From page 177... ...
Association with insurance status and likelihood of survival are independent of injury severity and demographic characteristics. In aggregated analysis, for non-Hispanic whites, both Medicaid eligibility and private insurance reduces the number of acute illness episodes.
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From page 178... ...
. 1nJury Hospital discharge rates (by age, race, median income of zip code, and insurance status)
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From page 179... ...
The proportion of discharges attributed to ACSCs was similar for those who were uninsured and those with private or other insurance but higher for those on Medicaid. The authors state that if the assumption is made that uninsured children are disadvantaged within the health care system and may have a higher percentage of discharges for ACSCs, it is likely that some of the findings for the uninsured could be attributed to .
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From page 180... ...
children matched with 20 children with private insurance from a pool of 63 with inflammatory bowel disease at a pediatric GI service Effect of Health on Children's Life Chances Hospital discharge rates for ACSCs Delayed presentation; disease severity at presentation In a lo children children CI = I white UndeI month under) erythr depres Acs et al.
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From page 181... ...
Household income and percentage of blacks and Hispanics in the population were predictors of the areas' hospitalization rates. The magnitude of the statistical population effect of otitis media with effusion on language development is low.
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From page 182... ...
Literature review Existence of asthma surveillance program Anemia Parent or teacher ratings of problem behavior and social skills, parent ratings of stress and family functioning, medical functioning, observations of parent-child interactions, classroom behavior, and test of preacademic skills Dental caries Asthma comma than 1< asthma import asthma in start Anemi range. highest years a of ones The pi was 03 3 and Young than t!
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From page 183... ...
Asthma affects more than 14 million persons in the United States. Asthma is the most common chronic disease of childhood, affecting approximately 5 million children aged less than 18 in the United States.
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From page 184... ...
Percept Mot Skills q Data from children involved in a project designed to standardize the Gordon Diagnostic System (n = 83 students who failed a grade; n = 93 normal) Multiple measures of access, use, and health status.
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From page 185... ...
Uninsured children are the least likely population group to have routine access to a physician. Among American children, 20% have chronic problems that could impose on their ability to function effectively in school and at home; 10% of children have one or more severe chronic conditions and account for 70-80% of all medical expenditures for children.
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From page 186... ...
Am J Dis Child Seven studies in which Hb levels in early childhood were linked to cognitive development or school achievement 99 children with moderately severe to severe chronic asthma Studies were reviewed looking for causal relationship between iron deficiency and children's cognition and behavior Performance on standardized achievement tests Most cogni child more status less t] devel devel dame Test asthn low s emot .
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From page 187... ...
Factors associated with low performance scores were low socioeconomic status, older age, history of continuous oral steroids, and presence of emotional and behavioral problems. Investigation of poor classroom performance of a child with chronic asthma should include investigation of the roles of socioeconomic status, oral steroid therapy, and emotional and behavioral problems.
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From page 188... ...
Literature review of 19 studies 191 participants in San Jose, Costa Rica, follow-up to original study (age 5) Changes in the prevalence of otitis media and associated risk factors for recurrent otitis media Performance on scholastic achievement test Dental caries and mutans Streptococcus Iron deficiency and iron deficiency anemia Reading achievement Cognitive, socioemotional, and motor tests, and measures of school functioning The ~ incre; from OCCUI condi CI 0.
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From page 189... ...
This difference remained significant after controlling for socioeconomic status. Children who have iron deficiency anemia in infancy are at risk for long-lasting developmental disadvantages compared to their peers.
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From page 190... ...
(2000) Poor Behavioral and Developmental Outcomes More Than 10 Years After Treatment for Iron Deficiency in Infancy.
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From page 191... ...
These results indicated that iron deficiency anemia in infancy was associated with alterations in affect and activity. Children with severe chronic iron deficiency in infancy scored lower on measures of mental and motor functioning even after controlling for background factors.
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From page 192... ...
(1999) Psychological and Electroncephalographic Study in School Children with Iron Deficiency.
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From page 193... ...
Aside from the well-known effect of iron deficiency on intellectual performance during childhood, the EEG power spectrum of iron-deficient children had a slower activity than that of control children suggesting a developmental lag and/or CNS dysfunction. High-absentee children were compared to low-absentee children from the same grades.
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From page 194... ...
(2000) Otitis Media in Early Childhood in Relation to Preschool Language and School Readiness Skills Among Black Children.
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From page 195... ...
Otitis media and associated hearing loss were significantly positively correlated with measures of expressive language at 3 and 4 years of age. However, this relationship did not remain significant when the child's gender, socioeconomic status, maternal educational level, and the responsiveness and support of the home and child care environments were accounted for.
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From page 196... ...
(1996) Effect of Prenatal Care on Obstetrical Outcome.
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From page 197... ...
59%; p <.001) , 6.3 times more likely to be staff patients (no private insurance)
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From page 198... ...
Hospital discharge data on births to residents of an eight-county region of California from the Office of Statewide Health Planning and Development for the last half of 1982, all of 1984, and 1986 In California civilian acute care hospitals, a populationbased sample, including all newborns discharged in 1987 with evidence of serious problems (n = 29,751) Cesarean sections Use of prenatal care and low birthweight Access to and use of pregnancy or birth services and subsequent maternal and pediatric outcomes Adverse outcomes among newborns; transfer to another acute care hospital or to a long-term care facility; death Length of stay, total charges, and charges per day Over.
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From page 199... ...
increased slightly from 10.4 to 10.6% Among pregnant women, 17% of the uninsured reported fair or poor health status compared to 6.8% of privately insured patients. In addition, 29% of the uninsured pregnant women reported not having a usual source of care compared to 14% of Medicaid-enrolled patients and 9% of privately insured women.
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From page 200... ...
Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women. J Political Econ Birth certificates linked to Medicaid enrollment files for Missouri CPS state-level aggregate birth and death statistics, United States Untimely initiation of care, too few visits, and no prenatal care Timely prenatal care Transfer to hospitals with neonatal ICUs Prenatal care use and low birthweight and/or prematurity Pregnant women eligible for Medicaid or deliveries covered by Medicaid; prenatal care use; low birthweight or prematurity; infant mortality Pregnant women eligible for Medicaid, deliveries covered by Medicaid, and infant mortality Despite Compa uptime: 95% C OR = 95% C (adj.
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From page 201... ...
Medicaid coverage increased the likelihood of antenatal transfer for white women. An increase in the Medicaid-eligible population was associated with a reduced percentage with late prenatal care; results were more pronounced for white women (those with late prenatal care declined from 22.3% to 21.8%)
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From page 202... ...
J Pub Econ Currie and Grogger (2002) Medicaid Expansions and Welfare Contractions: Off-setting Effects on Prenatal Care and Infant Health.
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From page 203... ...
Increases in Medicaid eligibility had statistically significant effects on use of prenatal care: reducing the probability of inadequate care for both white and black women; increasing the proportion of each group getting care in the first trimester; and reducing late initiation of care by both groups of women. Increases in Medicaid eligibility slightly reduced the probability of very low birthweight babies to white mothers.
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From page 204... ...
and 1987 (n = 64,346) Fetal death ratio Number of neonatal intensive care beds in a hospital Satisfaction rates, care initiated before the third trimester, and adverse infant outcomes Rates of adverse maternal outcome and cesarean section for uninsured women and for two concurrent control groups: women with Medicaid and women with private insurance A prom overall years of the pro medical · r slgn,ncc program time pe After at affiliati; those more n remain Betwee for all ~ birth Ql care an adverse In 1984 private!
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From page 205... ...
In 1984, uninsured women had higher rates of adverse maternal health outcome than privately insured women (5.5% and 5.1%, respectively) and received fewer cesarean sections (17.2% and 23.0%, respectively)
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From page 206... ...
(1991) Prenatal Care Use and Health Insurance Status.
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From page 207... ...
Medicaid expansions were associated with a reduced percentage (from 20.8% to 19.2%) of white women receiving late or no prenatal care in the South and Midwest.
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From page 208... ...
) , 1991 Delivery where there was a newborn intensive care unit Pregnant women eligible for Medicaid or deliveries covered by Medicaid Pregnant women eligible for Medicaid or deliveries covered by Medicaid and prenatal care use Health insurance coverage, health status, access to care, use of care, and satisfaction Women covered by Medicaid and/or deliveries covered by Medicaid Result Hospi influx are or derive privet' An ex of bird the ye no ch There the gr The p Medic inadec (1 8.59 of pre birth.
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From page 209... ...
An expansion to all married women meeting income requirements increased the percentage of births covered by Medicaid from 22 to 29%. The year before Medicaid was compared to the year after; there were no improvements in the use of prenatal care in the first trimester, no changes in the rates of very low and moderately low birthweight and neonatal mortality.
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From page 210... ...
210 HEALTH INSURANCE IS A FAMILY MATTER Sample Size/ Data Source Outcome Measures Findings Weis (1992) Uninsured Maternity Clients: A Concern for Quality.
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From page 211... ...
Insurance coverage and prenatal care were positive predictors of birthweight, while life-style risk factors detracted. Length of stay was not influenced by insurance coverage but rather by health problems before delivery.
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