Showing papers by "Neal Halfon published in 1996"

Routine emergency department use for sick care by children in the United States.

Abstract: Background. The use of the emergency departments as a regular source of sick care has been increasing, despite the fact that it is costly and is often an inappropriate source of care. This study examines factors associated with routine use of emergency departments by using a national sample of US children. Methods. Data from the 1988 National Health Interview Survey on Child Health, a nationally representative sample of 17 710 children younger than 18 years, was linked to county-level health resource data from the Area Resource File. Bivariate and multivariate analyses were used to assess the association between children's use of emergency departments as their usual sources of sick care and predisposing need and enabling characteristics of the families, as well as availability of health resources in their communities. Results. In 1988 3.4% or approximately 2 million US children younger than 18 years were reported to use emergency departments as their usual sources of sick care. Significant demographic risk factors for reporting an emergency department as a usual source of sick care included black versus white race (odds ratio [OR], 2.08), single-parent versus two-parent families (OR, 1.53), mothers with less than a high school education versus those with high school or more (OR, 1.76), poor versus nonpoor families (OR, 1.76), and living in an urban versus suburban setting (OR, 1.38). Specific indicators of need, such as recurrent health conditions (asthma, tonsillitis, headaches, and febrile seizures), were not associated with routine use of emergency departments for sick care. Furthermore, health insurance status and specifically Medicaid coverage had no association with use of the emergency department as a usual source of sick care. Compared with children who receive well child care in private physicians' offices or health maintenance organizations, children whose sources of well child care were neighborhood health centers were more likely to report emergency departments for sick care (OR, 2.01). Children residing in counties where the supply of primary care physicians was in the top quintile had half the odds (OR, 0.50) of reporting emergency departments as usual sources of sick care. Conclusions. Reliance on hospital emergency departments for routine sick care is strongly associated with demographic and social characteristics of the child and family, the type and source of available well child care, and the supply of primary care physicians. Because health insurance status was not a significant predictor of use, public policies aimed at reducing the use of emergency departments by children will need to address other factors. These include the organizational characteristics and responsiveness of the health care system and the motivation of families for routine use of hospital emergency departments.

The impact of the vaccine for children's program on child immunization delivery : A policy analysis

Abstract: The Vaccine for Children (VFC) program was proposed as part of President Clinton's 1993 Childhood Immunization Initiative. It is a federal vaccine-financing program that pays for and distributes free vaccine to providers serving 4 classes of children: (1) Medicaid insured, (2) uninsured, (3) children with private insurance that does not cover immunizations, and (4) American Indian and Alaskan Native children. Despite support from major professional organizations, the VFC program has come under intense criticism, with critics arguing that the cost of vaccines is not a major barrier to immunization receipt. In this article, we analyze how the VFC program will influence the receipt of immunizations by children under different child health care delivery and financing systems. We conclude that the impact of VFC on access to immunizations will be uneven; however, VFC could significantly improve access to immunizations for the over one third of US children who are either uninsured or covered under Medicaid fee for service. With further augmentations and refinements, VFC could be fashioned to overcome significant and persistent barriers to the timely delivery of immunizations in our disjointed child health financing and delivery systems. (Arch Pediatr Adolesc Med. 1996;150:577-581)

Knowledge of the Childhood Immunization Schedule and of Contraindications to Vaccinate by Private and Public Providers in Los Angeles

Abstract: Background Missed opportunities to vaccinate occur commonly and contribute to the underimmunization of young children. They are related to provider knowledge of the immunization schedule and contraindications to vaccination. Methods We surveyed private physicians (n = 50) and public health department physicians and nurses (n = 47). The questionnaire presented two sets of clinical scenarios in which they had to assess what immunizations were due and assess whether there were any contraindications to vaccination. Results The mean percent correct responses on the immunization schedule questions was 64% (sd = 3.6%) for the private physicians, 71% (SD = 4.7%) for the public physicians and 78% (SD = 2.8%) for the public nurses (P = 0.04). The mean percent correct responses on the contraindications to vaccinate questions was 73% (SD = 5.4%) for public physicians, 58% (SD = 3.3%) for private physicians, and 55% (SD = 4.7%) for public health nurses (P = 0.02). Conclusions Our survey shows that providers in the public and private sectors have important deficits in their knowledge of the immunization schedule and the appropriate contraindications to vaccinate which might lead to missed opportunities to vaccinate and low immunization coverage.