Health insurance and utilization of medical care for children with special health care needs.

Based on analyses of the 1988 National Center for Health Statistics, National Health Interview Survey, Child Health Supplement, this study examines the insurance coverage and utilization of physicians, hospitals, and prescribed medicine among the 9.6 million U.S. children with special health care needs, defined as children who had one or more selected chronic conditions that caused them to experience pain, discomfort, or being upset often or all of the time in the last year, or who were limited in their major childhood activities (playing or going to school) as a result of these or other impairments or health problems. The findings confirmed that substantial variation in access to routine medical care exists among these children. Though health status is an important predictor of which children use services in general, poor, minority children who lived with their mother or someone other than their parents, or those without insurance or an identifiable regular medical provider were most likely to experience financial barriers to access or were less apt to seek care than other children with comparable needs. Access to routine medical care remains particularly problematic for these subsets of children with special health care needs.

Health characteristics by longest held occupation and industry of employment: United States, 1980.

Occupational and industrial hazards are unevenly distributed in the workplace. National estimates for selected health indices of persons aged 17 years and over in the civilian noninstitutionalized population are presented for categories of longest held occupation and industry of employment. These estimates were based on data collected by the National Center for Health Statistics (NCHS) in the 1980 National Health Interview Survey (NHIS) and the Occupational Supplement, the first survey to collect data on longest held, in addition to current, occupation and industry of employment. Data on length of longest held job, limitation of activity, disability days, incidence of acute conditions, persons injured, hospitalizations, and utilization of medical and dental services are presented.

Use of specialty psychiatric settings in constructing DRGs.

Characteristics of a psychiatric setting, such as staffing intensity and scope of services, are examined to see if they contribute to explaining variation in length of stay over that explained by commonly available patient descriptors. For short-stay admissions (less than 31 days), only a small improvement in predictive ability was found. Implications for prospective payment systems are discussed.

Effect of curtailed insurance benefits on use of mental health care. The Tenneco health plan.

This article presents the impact of a health insurance benefit redesign on utilization and costs for mental health care in a large corporation. The design change primarily limited coverage to 45 days of hospitalization and 20 outpatient visits. Group health insurance data before and after the benefit changes (effective January 1, 1984) were compared and analyzed. Per capita charges for mental health care between 1983 and 1985 decreased by 41%, from $89 to $53. Responses to the benefit modifications differed for inpatient and outpatient services. Inpatient costs and length of stay decreased dramatically, especially for dependents, while utilization rates remained about the same. Statistically significant increases occurred for outpatient care utilization and costs.

Mortality transition in Korea: its implications for health policy and education.

This paper discusses the progress and prospects for mortality reduction in Korea, drawing upon the scanty data available in the literature. Data suggest that recent mortality improvement in Korea is slowing; that male mortality patterns at older ages are deviating from model life tables: that infant and child mortality is relatively high; and that transitional changes in the cause-of-death structure of infants and children are lagging behind their elders. Implications of these trends form a principal basis for concern about health policy issues in Korea. Any continuing progress in mortality would require major effort in several areas: accurate and adequate assessment of disease patterns and health behavior; reexamination of current health care strategies and public health measures; and analyses of social and economic development policies relevant to health conditions.

Validity of the Spanish surname infant mortality rate as a health status indicator for the Mexican American population.

This study assessed the validity of the Spanish surname infant mortality rate as an index of urban Mexican American health status. Neonatal, postneonatal, and risk-factor-specific mortality rates were computed from linked birth and infant death records of the 1974-75 Harris County, Texas, cohort of 68,584 for Spanish surname White, non-Spanish surname White, and Black single live births. Infants of Mexican-born immigrants were distinguished from those of other Spanish surname parents by parental nativity information on birth records. Infants of Mexican immigrants had paradoxically low mortality rates for high birth order, high maternal age, and delayed or absent prenatal care; only infants weighing less than 1500 gm showed expected high rates. Findings suggested loss of infant death data compatible with migration and under-registration of deaths. The Spanish surname infant mortality rate may be spuriously low and does not appear to be a valid indicator of Mexican American health status even in an urban, non-border area considered to have excellent birth and death registration.

DRGs in psychiatry. An empirical evaluation.

On October 1, 1983, Medicare began paying general hospitals by a prospective payment system based on DRGs. Psychiatric settings are exempted automatically or by request. By January 1985, however, a decision is required on how to integrate psychiatric settings into this system. This article provides an empirical analysis of the current DHHS DRGs categories for mental disorders. Current mental disorder DRGs and alternate DRGs examined here explain less than 3-12% of the variation in psychiatric length of stay. This is in contrast to 30-50% explained variation for other disorders. Alternatives and policy implications are discussed.

Diagnosis-related groups for mental disorders, alcoholism, and drug abuse: evaluation and alternatives.

Under the new federal prospective payment system, 15 of the 467 diagnosis-related groups (DRGs) cover mental disorders, including alcohol and substance abuse. The authors compare these 15 DRGs with some criteria of an ideal patient classification system. According to their assessment, the DRGs for mental disorders pose no administrative problems, but are not sufficiently homogeneous within categories or heterogeneous between categories. The authors conclude by discussing their own attempt to develop alternative DRGs, based on such variables as age, marital status, and type of treatment as well as on diagnosis.

Factors affecting the choice of nonpermanent contraceptive methods among married women.

PIP: Data from the 1976 US National Survey of Family Growth were used to examine the effect of sociodemographic factors on choice of nonpermanent contraceptive methods among white, fecund, married women aged 15-44 who intend no additional births. A multivariate analysis revealed that age of the respondent had a strong negative relationship to the effectiveness of contraceptive chosen. Being Catholic had a negative effect on the effectiveness of contraceptive chosen, but significant interaction occurred between age and parity and between age and education. 1 explanation may be that increased age may result in reduced perception of risk that an unwanted birth will occur. Another explanation is that concerns about health risks associated with the pill or IUD use may lead to use of other methods among older women. The most probable explanation of the observed relationship is a cohort effect. Older women who began marital contraception at an earlier point in time have continued to use the same methods as were initially available early in their marriage. The lack of a significant association between parity and the effectiveness of contraceptive method chosen based on multivariate analysis is most likely due to the high correlation between parity and age. The lack of a significant effect of education on choice of method may be explained by the nearly universal access to all methods of contraception for married women. Further research on the same lines is strongly urged to shed light on current behavior patterns.^ieng

The health of Mexican Americans: evidence from the human population laboratory studies.

Data are presented from sample surveys conducted in 1974 (N = 3,119) and 1975 (N = 657) in Alameda County, California, by the Human Population Laboratory. Mexican Americans are compared to Anglos and Blacks on selected health status indicators; chronic conditions, disability, symptoms and a summary measure, the Physical Health Spectrum. Comparisons of crude percentages indicate that, compared to Anglos, Blacks report having more chronic conditions, more disability and more symptoms, while Chicanos generally report fewer health problems than these two groups. Controlling for the effects of age, sex, education, family income, marital status, and perceived health reduces the Anglo/Black differentials in reported health problems, primarily by reducing the rates for Blacks. However, even after adjustment the prevalence rates for Blacks remain higher. After controlling for the effects of the six covariates, the rates for Chicanos remain essentially unchanged in both samples, e.g., lower than the other groups. Results of binary regression analysis indicate that the two most powerful predictors of health status in both samples are age/sex and perceived health. Ethnicity overall is not a good predictor of health status, accounting for 1 per cent or less of the explained variance. Socioeconomic status, while predicting slightly better than ethnicity, still accounts for less than 2% of the variance in health status.

Medical care use by Mexican-Americans: evidence from the human population laboratory studies.

Data are presented from sample surveys conducted in 1974 (N = 3,119) and 1975 (N = 657) in Alameda County, California, by the Human Population Laboratory. Mexican-Americans are compared to Anglos and blacks in terms of physician visits, dental examinations, general physical examinations, and eye examinations. Comparison of crude percentages indicates that there is very little ethnic variation in either sample regarding regular source of medical care or health insurance coverage, although the trend is for fewer Chicanos to have such coverage. In terms of physician visits, there is little difference between Anglos and Chicanos. By contrast, fewer Chicanos and blacks report dental examinations in the past year (Chicanos have the lowest rate). Fewer Chicanos report a general medical examination in the past year and more report never having had a medical checkup. Likewise, more Chicanos report never having an eye examination while relatively fewer report such an exam in the past year. Controlling for the effects of age, sex, education, family income, health insurance, regular source of care, physical health status and perceived health reduces differences in rate of physician visits among the ethnic groups, primarily by reducing the rate for blacks and increasing the rate for Chicanos. Likewise, adjustment for all 8 factors reduces ethnic differences in general medical examination rates, in this case by increasing the rates for the minority groups. Adjustment reduces the ethnic differences in dental examination rates by increasing the minority group rates, but large differences still remain. For eye examinations, adjustment has little effect on the rates for Anglos and blacks, but substantially increases the rate for Chicanos. For all 4 types of medical care behavior, controlling for the effects of education and family income (so-called inequitable reasons for lower access to care) consistently produces the greatest effect, particularly for Chicanos. In each case, the effect is to create greater parity between Chicanos and Anglos by increasing the utilization rate for Chicanos. However, even after adjustment, the rate for Chicanos remains lower.