Abstract:
OBJECTIVE:More than 25 million children in the United States are dependent on federal and state medical insurance programs for their health care needs. In California, 3.25 million children depend on Medi-Cal for their health insurance. In Southern California alone, the figure is as high as 1.81 million. However, 9.30 million children nationally and 1.55 million in California have no health insurance. Various public policies that would increase enrollment in these programs are being discussed to address this problem. However, before their implementation, it is important to understand what impact such policies would have on the actual delivery of health care to this patient population. In California, 2 predominant health care delivery models exist for Medi-Cal: a fee-for-service (so-called regular or straight Medi-Cal) and a managed care plan. One third of the children in Medi-Cal in the state are enrolled in the fee-for-service plan with the remainder in the managed care plan, whereas in Southern California, this figure is slightly lower at 28% in the fee-for-service plan. The objective of this study was to determine the number of otolaryngologists in Southern California who would offer a new patient appointment for an evaluation for tonsillectomy for a child with commercial insurance versus government-funded (Medi-Cal) insurance through direct contact with the physician and to determine whether the surgeon would offer to perform the procedure or refer the patient to another institution and to identify the specific reason(s) for any disparity in access to health care. METHODS:A written questionnaire was sent via regular mail to 303 otolaryngologists in the Southern California area in 2003. RESULTS:A total of 100 fully completed questionnaires were received. Ninety-seven surgeons would offer an office appointment to a child with commercial insurance as compared with only 27 for a child with Medi-Cal. Of those 27 surgeons, 8 would then refer the child to another physician to perform the surgery, and only 19 would actually offer to perform surgery, if indicated. Reasons provided for not offering an office appointment or surgery for the child with Medi-Cal include excessive paperwork and/or administrative burdens (96%), low monetary reimbursement for the surgery (92%), and low monetary reimbursement for the office visit (87%). CONCLUSIONS:There is a tremendous inequality of access to surgical specialty health care for children with government-funded insurance when compared with those with commercial insurance in Southern California. Physicians indicate that this disparity is related to excessive administrative burdens and low monetary reimbursement. The implications of our findings on public health care policies are discussed.
journal_name
Pediatricsjournal_title
Pediatricsauthors
Wang EC,Choe MC,Meara JG,Koempel JAdoi
10.1542/peds.2004-0210subject
Has Abstractpub_date
2004-11-01 00:00:00pages
e584-90issue
5eissn
0031-4005issn
1098-4275pii
114/5/e584journal_volume
114pub_type
杂志文章相关文献
PEDIATRICS文献大全abstract:BACKGROUND AND OBJECTIVE:Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the perce...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2015-3832
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To determine the frequency of child abuse and unintentional injury as a cause of infant and toddler subdural hemorrhage (SDH). METHODS:A prospective case series of a level I regional trauma center, regional children's hospital, and county medical examiner's office assessed consecutive children who were =36...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.108.3.636
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVES:To determine whether adjunctive therapy with recombinant human granulocyte colony-stimulating factor (rhG-CSF) could reverse sepsis-associated neonatal neutropenia and improve neonatal survival compared with conventional therapy in a phase I/II-type trial. STUDY DESIGN:An intravenous infusion of rhG-CSF (10...
journal_title:Pediatrics
pub_type: 临床试验,杂志文章
doi:10.1542/peds.100.1.e6
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Investigative efforts to improve monitoring during sedation for patients of all ages are part of a national agenda for patient safety. According to the Institute of Medicine, recent technological advances in patient monitoring have contributed to substantially decreased mortality for people receiving general...
journal_title:Pediatrics
pub_type: 杂志文章,随机对照试验
doi:10.1542/peds.2005-1709
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:The goal was to determine whether patients seen in a referral clinic are experiencing initial allergic reactions to peanuts earlier, compared with a similar population profiled at a different medical center 10 years ago, and to investigate other changes in clinical characteristics of the patients between the ...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2007-0350
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Disparities in health service use have been described across a range of sociodemographic factors. Patterns of PICU use have not been thoroughly assessed. METHODS:This was a population-level, retrospective analysis of admissions to the Cincinnati Children's Hospital Medical Center PICU between 2011 and 2016....
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2019-0748
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVE:The National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) is a 10-year study to investigate the development of obesity in black and white girls during adolescence and its environmental and psychosocial correlates. The purpose of this report was to examine changes in the annual prevalence ra...
journal_title:Pediatrics
pub_type: 杂志文章,多中心研究
doi:10.1542/peds.110.5.e54
更新日期:2002-11-01 00:00:00
abstract:OBJECTIVE:To characterize neuroimaging, physical, neurobehavioral, and developmental findings in children with inflicted and noninflicted traumatic brain injury (TBI) and to identify characteristic features of inflicted TBI. METHODS AND PATIENTS:Forty children, 0 to 6 years of age, hospitalized for TBI who had no docu...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.102.2.300
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVE:To analyze the costs and benefits of influenza vaccination of healthy school-aged children. DESIGN:The analysis was based on data from the literature. Total costs included direct medical costs for vaccination, physician visits, and treatment as well as indirect costs. Indirect costs were in the form of lost ...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.103.6.e73
更新日期:1999-06-01 00:00:00
abstract::Psychogenic seizures in 21 nonepileptic children and adolescents, aged 8 to 18 (mean 14.5) years, were recorded by means of video recording and electroencephalography. The episodes included thrashing movements, limb jerking, or staring, with unresponsiveness. Ictal and interictal electroencephalograms showed no abnorm...
journal_title:Pediatrics
pub_type: 杂志文章
doi:
更新日期:1990-04-01 00:00:00
abstract::Three children with renal disease, hypertension, and the Cockayne syndrome were evaluated. All patients had severe hypertension; peripheral vein renin was elevated in two patients. Renal biopsy specimens from two patients were studied by light microscopy, electron microscopy, and immunofluoresence. Immunohistologic st...
journal_title:Pediatrics
pub_type: 杂志文章
doi:
更新日期:1979-12-01 00:00:00
abstract::Severe methemoglobinemia resulting from the use of topical benzocaine has been reported in adults as a rare complication. Here we report a case of severe acquired methemoglobinemia resulting from topical use of benzocaine spray during diagnostic upper gastrointestinal endoscopy in a 3-year-old boy with repeated episod...
journal_title:Pediatrics
pub_type: 杂志文章,评审
doi:10.1542/peds.2005-1952
更新日期:2006-04-01 00:00:00
abstract:OBJECTIVE:The incidence of nosocomial infections, predominantly gastrointestinal and respiratory, in children in developed countries is high, ranging from 5% to 44%. There is no effective strategy for preventing these infections. The objective of our study was to investigate the role of Lactobacillus GG (LGG) in preven...
journal_title:Pediatrics
pub_type: 杂志文章,随机对照试验
doi:10.1542/peds.2009-2568
更新日期:2010-05-01 00:00:00
abstract:OBJECTIVES:To estimate the prevalence of elevated blood lead levels in children receiving well-care checkups; and to evaluate the effectiveness of certain key risk factors in detecting children at higher risk for elevated blood lead levels. DESIGN:Cross-sectional study. SETTING:Two facilities of the Kaiser Permanente...
journal_title:Pediatrics
pub_type: 杂志文章,多中心研究
doi:
更新日期:1996-01-01 00:00:00
abstract::Beals syndrome, also known as congenital contractural arachnodactyly (Online Mendelian Inheritance in Man: 121050), is an autosomal dominant disorder caused by a mutation in FBN2 that is typically characterized by congenital contractures and arachnodactyly. It shares a number of phenotypic features with Loeys-Dietz sy...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2016-1281
更新日期:2017-03-01 00:00:00
abstract:OBJECTIVES:To assess characteristics associated with health care spending trends among child high resource users in Medicaid. METHODS:This retrospective analysis included 48 743 children ages 1 to 18 years continuously enrolled from 2009-2013 in 10 state Medicaid programs (Truven MarketScan Medicaid Database) also in ...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2016-0682
更新日期:2016-10-01 00:00:00
abstract::When a healthy infant dies suddenly and unexpectedly, it is critical to correctly determine if the death was caused by child abuse or neglect. Sudden unexpected infant deaths should be comprehensively investigated, ancillary tests and forensic procedures should be used to more-accurately identify the cause of death, a...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2019-2076
更新日期:2019-09-01 00:00:00
abstract::The public service orphan drug Human Botulism Immune Globulin for the treatment of infant botulism would not have come into existence without the federal Orphan Drug Act and the funding mechanism that it provided to conduct pivotal clinical trials. Nonetheless, creating, developing, and achieving licensure of Human Bo...
journal_title:Pediatrics
pub_type: 杂志文章,评审
doi:10.1542/peds.2006-0646
更新日期:2007-04-01 00:00:00
abstract::Thirty-two 5- to 17-year-old children who had severe, acute asthma were randomly assigned to receive either high doses (0.15 mg/kg of body weight per dose) or low doses (0.05 mg/kg of body weight per dose) of nebulized albuterol every 20 minutes for six doses. Compared with the low-dose regimen, the high-dose regimen ...
journal_title:Pediatrics
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1989-04-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to determine gender differences in pediatric patients with Crohn disease. METHODS:We conducted a retrospective cohort study of 989 consecutive pediatric patients (566 boys, 423 girls) who had Crohn disease (aged 0 to 17 years at diagnosis) by using the Pediatric IBD Consortium...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2007-0905
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:The goal of this study was to determine if congenital human herpesvirus-6 (HHV-6) infection influences early neurodevelopment. METHODS:We enrolled 57 newborns with HHV-6 congenital infection and 242 control newborns without congenital infection into a prospective, double-blind study with 4 visits between 4 a...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2014-0886
更新日期:2014-12-01 00:00:00
abstract::Heart rate and blood pressure changes following 0.5% tropicamide and 2.5% phenylephrine hydrochloride were evaluated in seven ill preterm infants (birth weight, 910 to 2,060 gm; gestational age, 26 to 36 weeks) during the first day of life. Each infant was monitored continuously for 30 minutes before and for 75 minute...
journal_title:Pediatrics
pub_type: 杂志文章
doi:
更新日期:1981-08-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to determine the rate of compliance with hospital guidelines for alarm limits for pulse oximetry in preterm infants on oxygen therapy. METHODS:All infants admitted to the nurseries at the Royal Women's Hospital, Melbourne, Australia, with gestational age <32 weeks or birth wei...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2006-3099
更新日期:2007-06-01 00:00:00
abstract:OBJECTIVE:Accurate, timely diagnosis of pediatric appendicitis minimizes unnecessary operations and treatment delays. Preoperative abdominal-pelvic computed tomography (CT) scan is sensitive and specific for appendicitis; however, concerns regarding radiation exposure in children obligate scrutiny of CT use. Here, we c...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2012-1665
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:We sought to determine if an association exists between the use of histamine-2 receptor (H2) blockers and the incidence of necrotizing enterocolitis (NEC) in infants of 401 to 1500 g in birth weight. STUDY DESIGN:Data from the National Institute of Child Health and Human Development Neonatal Research Network...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2005-1543
更新日期:2006-02-01 00:00:00
abstract::This clinical report defines common terms of use and provides information on current practice, research, and limitations of assistive technology that can be used in systems for communication. The assessment process to determine the best devices for use with a particular child (ie, the best fit of a device) is also rev...
journal_title:Pediatrics
pub_type: 杂志文章,实务指引
doi:10.1542/peds.2008-0695
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVE:Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no similar investigation has ever been conducted in young children. METHODS:We recruited 241 children aged 5 to...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2005-2920
更新日期:2006-08-01 00:00:00
abstract::Pediatric care providers, pediatricians, pediatric subspecialty physicians, and other health care providers should be able to recognize children with abnormal head shapes that occur as a result of both synostotic and deformational processes. The purpose of this clinical report is to review the characteristic head shap...
journal_title:Pediatrics
pub_type: 杂志文章
doi:10.1542/peds.2020-015511
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:To identify adverse behavioral and psychological factors associated with forced sex experiences of adolescent girls compared with their sexually active counterparts. METHOD:An anonymous self-report survey examining an array of psychosocial items, to which 3124 grade 8 and grade 10 female students responded. ...
journal_title:Pediatrics
pub_type: 临床试验,杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract:OBJECTIVES:To review the relationship between parent and child literacy and child health outcomes and interventions designed to improve child health outcomes for children or parents with low literacy skills. METHODS:We searched Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for artic...
journal_title:Pediatrics
pub_type: 杂志文章,评审
doi:10.1542/peds.2009-1162B
更新日期:2009-11-01 00:00:00