Showing papers by "Neal Halfon published in 2000"

Access to Health Care for Children With Special Health Care Needs

Abstract: Objective. To assess the role health insurance plays in influencing access to care and use of services by children with special health care needs. Methods. We analyzed data on 57 553 children younger than 18 years old included in the 1994–1995 National Health Interview Survey on Disability. The survey obtained information on special health care needs, insurance status, and access to and use of health services. Bivariate and multivariate analyses were used to assess the association of insurance with several measures of access and utilization, including usual source of care, site of usual care, missed or delayed care, and use of ambulatory physician services. Results. Using the federal Maternal and Child Health Bureau definition of children with special health care needs, we estimate that 18% of US children under 18 years old had an existing special health care need in 1994–1995. An estimated 89% of these children had some form of health insurance coverage, most often private health insurance. Insured children were more likely than uninsured children to have a usual source of care (96.9% vs 79.2%). Among those with a usual source of care, insured children were more likely than uninsured children to have an identified regular clinician (87.6% vs 80.7%). Insured children were less likely to report unmet health needs, including medical care (2.2% vs 10.5%), dental care (6.1% vs 23.9%), prescriptions, and/or eyeglasses (3.1% vs 12.3%), and mental health care (.9% vs 3.4%). Insured children were also more likely to have a physician contact in the past year (89.3% vs 73.6%) and have more physician contacts on an annual basis (8.5 vs 4.1 contacts). Unexpectedly, no differences were found between insured and uninsured children in availability of after hours medical care (evenings and weekends) or satisfaction with care. We also found some modest differences in access between publicly and privately insured children. Privately insured children were more likely to have a usual source of care (97.6% vs 95.3%) and a regular clinician (91.0% vs 81.1%). Privately insured children were also less likely to report dissatisfaction with care at their usual site of care (14.9% vs 21.0%) and have access to care on evenings and weekends (6.8% vs 13.4%). No substantial differences were found between privately and publicly insured children in prevalence of unmet health needs or delays in obtaining care due to cost. Conclusions. This study illustrates the importance of health insurance for children with special health care needs. Continued efforts are needed to ensure that all children with special health care needs have insurance and that remaining access and utilization barriers for currently insured children with special health care needs are also addressed.

Prevalence, Impact, and Trends in Childhood Disability Due to Asthma

Abstract: Background Although not widely recognized as such, asthma is the single most prevalent cause of childhood disability and has contributed to a substantial rise in the overall prevalence of disability among children during the past 25 years. Objective To provide a national profile of the prevalence, impact, and trends in childhood disability due to asthma. ( Disability is a long-term reduction in the ability to participate in children's usual activities, such as attending school or engaging in play, due to a chronic condition.) Methods We derived our primary findings from a cross-sectional, descriptive analysis of 62,171 children younger than 18 years who were included in the 1994-1995 National Health Interview Survey. Main Outcome Measures Outcome measures include the presence of disability, degree of disability, restricted activity days, school absence days, and use of hospital and physician services. We also used data from the 1969-1970, 1979-1981, and 1994-1995 National Health Interview Surveys to assess trends in the prevalence of disability due to asthma. Results A small, but significant, proportion of children, estimated at 1.4% of all US children, experienced some degree of disability due to asthma in 1994-1995. Prevalence of disability due to asthma was higher for adolescents (odds ratio [OR], 1.64), black children (OR, 1.66), males (OR, 1.23), and children from low income (OR, 1.46) and single-parent families (OR, 1.37). Disabling asthma resulted in an annual average of 20 restricted activity days, including 10 days lost from school—almost twice the level of illness burden as experienced by children with disabilities due to other types of chronic conditions. Finally, prevalence of disabling asthma, as reported in the National Health Interview Survey, has increased 232% since 1969, the first year that electronic data are available from the survey. In contrast, prevalence of disability due to all other childhood chronic conditions increased by 113% over the same period. Conclusions Disabling asthma has profound effects on children. The social costs of asthma are likely to rise in the future if current trends in the prevalence of disabling asthma continue.

Firearm storage patterns in US homes with children.

Abstract: OBJECTIVES: This study determined the prevalence and storage patterns of firearms in US homes with children. METHODS: We analyzed data from the 1994 National Health Interview Survey and Year 2000 objectives supplement. A multistage sample design was used to represent the civilian noninstitutionalized US population. RESULTS: Respondents from 35% of the homes with children younger than 18 years (representing more than 22 million children in more than 11 million homes) reported having at least 1 firearm. Among homes with children and firearms, 43% had at least 1 unlocked firearm (i.e., not in a locked place and not locked with a trigger lock or other locking mechanism). Overall, 9% kept firearms unlocked and loaded, and 4% kept them unlocked, unloaded, and stored with ammunition; thus, a total of 13% of the homes with children and firearms--1.4 million homes with 2.6 million children--stored firearms in a manner most accessible to children. In contrast, 39% of these families kept firearms locked, unloaded, and separate from ammunition. CONCLUSIONS: Many children live in homes with firearms that are stored in an accessible manner. Efforts to prevent children's access to firearms are needed.

The Health Development Organization: An Organizational Approach to Achieving Child Health Development

Abstract: The health development organization (HDO) is a new approach to the organization and delivery of children’s health and social services. The HDO would combine the best features of vertically integrated HMOs with horizontally integrated, child-focused social services and longitudinally integrated health promotion strategies. Its mandate would be to develop the health of children in a community. The impetus for creating HDOs is a growing body of evidence in chronic disease epidemiology, developmental psychopathology, early intervention research, and life course cohort studies that point to childhood as the period of life during which adult health status is determined and the opportunities for health capital formation are highest. Thus, a new kind of health care organization or framework, like the HDO, is needed to integrate a full range of critical services for promoting children’s development.

Commentary: monitoring expanded health insurance for children: challenges and opportunities.

Abstract: Enacted in 1997 as Title XXI of the Social Security Act, the State Children's Health Insurance Program (SCHIP) offers significant potential for expanding health insurance for children and improving their access to care.1 According to the states, nearly 2 million children were enrolled by October 1999.2 Ultimately, 3 million uninsured children in low-income families, or about one third of all US uninsured children, could eventually gain coverage under SCHIP.3 Moreover, SCHIP outreach efforts may also lead to increased enrollment levels of children already eligible for Medicaid. More than 2 years have now passed since enactment of the program and many of the components needed to monitor the program are now in place. These include a new template to assist states in meeting federal reporting requirements, an external evaluation funded by the Health Care Financing Administration (HCFA), several SCHIP research projects funded through the Agency for Healthcare Research and Quality. The enactment of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 further enhances the prospects for a comprehensive approach to monitoring. This act, incorporated in one of the final appropriations bills for fiscal year 2000 (Public Law 106-113), not only included new appropriations for data collection and evaluation as indicated above, but also expands Congressional oversight by specifying periodic audits by the Inspector General of the Department of Health and Human Services combined with monitoring reports from the General Accounting Office to assess progress in reducing the number of uninsured low-income children. The legislation also directs the federal Department of Health and Human Services to take an active role in coordinating and consolidating data and reports regarding children's health. In this commentary, we outline several elements of a comprehensive national monitoring program and discuss how these new data collection and evaluation initiatives fit within this …