Showing papers by "Neal Halfon published in 1994"

The health care needs of children in foster care: a research agenda.

Abstract: The health and mental health problems of the children in out-of-home care present many challenges to child welfare agencies and demand closer collaborative relationships among a variety of professional groups. Despite generally well-accepted guidelines for action and strong evidence suggesting that appropriate care may result in significant benefit to the children, many questions remain as to the most effective and efficient methods of providing these services at the individual, system, and policy levels. At the present time, a small number of programs are attempting to implement various parts of the CWLA and AAP recommendations for health and mental health services for children in out-of-home care. It is not certain, however, how efforts to reform the health care system may affect the delivery of services to this population. Research efforts should concentrate on collecting and evaluating data from existing programs at all three levels (individual, system, policy) to aid in refining and directing future policy and practice in the field of child welfare.

Children with chronic illness and Medicaid managed care.

Abstract: Incorporating these suggestions would necessitate a significant commitment of funds and other resources on the part of federal and state governments. This level of commitment is necessary if children with chronic conditions from low-income families are to receive appropriate care and their sponsors receive fair value. However, attending to the suggestions made in this commentary—while necessary—will not automatically assure that chronically ill children receive the services they need. All too often the emphasis of Medicaid managed care is on managing costs rather than managing care. It is only through a more enlightened perspective—one that places a greater emphasis on what is best for children and a lesser emphasis on what is best for budgets—that chronically ill children will receive the care they deserve.

Access to infant immunizations for poor, inner-city families: what is the impact of managed care?

Abstract: California plans to enroll half of its Medicaid population, 75 percent of which are children, into managed care. To measure the impact of managed care on utilization of preventive services, we surveyed 867 families in two inner-city areas of Los Angeles and assessed the relationship between insurance type, source of care, andaccess to immunization services. Compared to children in public health clinics, those in private physicians' offices or health maintenance organizations (HMOs) had odds of being up-to-date on immuni- zations of 0.43 (p<.01 ) and 0.24 (p<.01), respectively. We conclude that in the absenceofmeaningful financial incentives to encourageprivatephysicians and HMOs to provide immunizations to inner-city children, managed care is unlikely to improve immunization rates among this vulnerable population.

National Health Care Reform, Medicaid, and Children in Foster Care.

Abstract: The unique health, legal, and social status of children in foster care* poses particular problems for the designers of any kind of health plan. Because many children in out-of-home care are highly mobile, moving from family to family, and from one geographic locale to another, the context of their lives challenges the assumptions that health insurance is based upon. This article attempts to highlight current access to health care services for this group of children, how the President's proposed Health Security Act would affect the delivery of health care services, and what special considerations are necessary to meet the needs of this particular group of children. We have focused on the President's plan partially because it provides the greatest amount of detail, and partially because it has the greatest likelihood of doing the most to improve the availability of appropriate health care services for children in general, and children in foster care in particular.** The analysis printed here is based upon the version of the American Health Security Act that was introduced in Congress by members of the House and Senate on November 22, 1993 (H.R. 3600/S. 1757). This most recent version of the Health Security Act has incorporated changes that greatly improve the extent of coverage and other considerations for children in foster care compared to earlier drafts of the plan.Studies have documented that while children in foster care experience high rates of serious health problems, they also face significant obstacles in their access to essential health care services. Although professional organizations such as the American Academy of Pediatrics and the Child Welfare League of America have developed excellent standards for health care services for children in foster care, the actual delivery of health care services to this needy population falls far short of these standards. The reasons for this failure relate to both the financing of services and the organization of care. President Clinton's proposed American Health Security Act of 1993 would have a major impact on the accessibility of health care services for children in foster care. In a number of important respects, the proposed plan would improve access, but in other critical areas it would limit essential care.HEALTH CARE ACCESS UNDER CURRENT LAW FOR CHILDREN IN FOSTER CAREWHO ARE THE CHILDREN IN FOSTER CARE?The population of children in foster care is growing rapidly. There were an estimated 460,000 children in foster care at the end of fiscal year 1993, with more than 659,000 served by the system during that year. In the wake of escalating and persistent poverty, family violence, mental illness, and the drug epidemic, the number of children in foster care has been increasing nationwide since 1985. It is projected that 500,000 to 600,000 children will be in foster care by 1995. The vast majority of these children live in family foster homes (70%); the remainder are in group homes, residential treatment centers, or institutional settings.WHAT ARE THE HEALTH CARE NEEDS OF CHILDREN IN FOSTER CARE?Children in foster care have high rates of serious health problems. Several studies have documented that children in foster care have high rates of chronic medical problems that require ongoing treatment. Approximately 60% of children in foster care have moderate to severe mental health problems. Children in foster care also experience high rates (40%) of physical health problems (e.g., asthma, growth disorders, neurological abnormalities). The high frequency of health and mental health problems is a result of the children's poor health prior to placement, the effects of abuse and neglect, the effects of separation and frequent moves, and the lack of access to appropriate health and mental health services. A particular concern is the increasing number of infants entering care with multiple health and developmental needs due in large part to maternal drug use and prenatal exposure to drugs. …

Where Is the Health in Health System Reform

Abstract: THE HEALTH system reform debate is over how to organize, deliver, and finance personal health care services. At $1 trillion, the enormity of the health care sector warrants a healthy debate about its structure and the respective roles of the public and private sectors. Erosion of middle-class health insurance coverage and an insecure economic and employment future have mobilized a broad constituency for insurance market reforms.1,2Distributive justice issues raise concern for the 40 million Americans without health benefits. Lost, however, among discussions of health security, universal coverage, and competitive markets is the unstated principal mission that any health system must serve toimprovethe health of the entire population. Legislators know that increasing public interest in health reform is attributable to the emergence of health insurance coverage as a middle-class issue.2,3An increasing proportion of the voting public has become part See also pp 1276 and 1297.