Index

A

Accountability, 19, 21, 155-156, 163, 168

Medicaid, 89-90, 94

SCHIP, 2, 14, 18, 42, 105, 118, 168

technical aspects, 22, 163-168

see also Performance measures

Acute illness, 5, 22, 47, 55, 72, 120, 121-122, 124-126, 137

see also Emergency care;

Injuries

Administrative barriers, 20, 54, 56, 113

Children's Medical Security Plan, 113

information technology and, 133

Medicaid, 87-88, 103, 113, 115, 150

special needs children, 127

taxation, IRS, 150-151, 152

vouchers, 150

Adults, 1

coverage trends, 22, 24-29, 151

disabled, defined, 131

homeless, 61, 68

Medicaid, 81, 82

needs, vs children, 19, 136, 151, 164

SCHIP, 70

state programs, subsidy structure, 111, 121

subsidies, 151

Supplemental Security Income, 130

uninsured, 4, 24, 26, 27, 68, 70

parents, 107, 151

see also Employer-based insurance;

Parents

AFDC, see Aid to Families with Dependent Children

African Americans

access to care, 41, 49, 51, 53, 54

insurance coverage, 3, 27, 32-33

Age factors

access to health care, 44

diseases, 121, 122

employer-based insurance, 27, 30-31

insurance coverage status, 21, 27, 30-31

Medicaid eligibility, 5, 83-84, 114

poverty thresholds, 38

state programs, 106, 114

see also Adults

Agency for Health Care Policy and Research, 17, 52, 157-158, 163

Aid to Families with Dependent Children, 12, 88, 96, 97

see also TANF

AIDS, see Human immunodeficiency virus

Alcohol and drug abuse, see Substance abuse

Alcohol tax, 104, 108

Allergies, 5, 120

Ambulatory care,

see Emergency care;

Outpatient care;

Primary care

Ambulatory Care Access Project, 47

American Academy of Pediatrics, 17, 55, 60

American Indians, see Native Americans

Arizona, 79

Asians/Pacific Islanders, 27, 32-33, 34, 53-54

Assessment, see Accountability;

Evaluation

Asthma, 3, 5, 46, 48, 53, 115, 117, 124, 125, 166

Attitudes

health beliefs, 25, 54

welfare recipients, embarrassment, 87-88, 104, 113

see also Health beliefs

Auditory disabilities, see Hearing impairments

B

Balanced Budget Act of 1997, 38, 68, 72, 85, 98-99, 128, 167

see also SCHIP

Behavioral disorders, 60, 98, 124, 128

Benchmark coverage, 61, 137, 140

Black persons, see African Americans

Block grants, 2, 4, 14, 69, 75, 79, 124, 125, 127, 128-129

Blue Cross/Blue Shield, 103, 115, 116, 126, 137

Bureau of Primary Health Care Programs, 69

Buy-in, Medicaid, 98

See also Cost sharing;

Sliding scale

C

California, 79, 103, 106, 109, 111, 115, 116, 117



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Index A Accountability, 19, 21, 155-156, 163, 168 Medicaid, 89-90, 94 SCHIP, 2, 14, 18, 42, 105, 118, 168 technical aspects, 22, 163-168 see also Performance measures Acute illness, 5, 22, 47, 55, 72, 120, 121-122, 124-126, 137 see also Emergency care; Injuries Administrative barriers, 20, 54, 56, 113 Children's Medical Security Plan, 113 information technology and, 133 Medicaid, 87-88, 103, 113, 115, 150 special needs children, 127 taxation, IRS, 150-151, 152 vouchers, 150 Adults, 1 coverage trends, 22, 24-29, 151 disabled, defined, 131 homeless, 61, 68 Medicaid, 81, 82 needs, vs children, 19, 136, 151, 164 SCHIP, 70 state programs, subsidy structure, 111, 121 subsidies, 151 Supplemental Security Income, 130 uninsured, 4, 24, 26, 27, 68, 70 parents, 107, 151 see also Employer-based insurance; Parents AFDC, see Aid to Families with Dependent Children African Americans access to care, 41, 49, 51, 53, 54 insurance coverage, 3, 27, 32-33 Age factors access to health care, 44 diseases, 121, 122 employer-based insurance, 27, 30-31 insurance coverage status, 21, 27, 30-31 Medicaid eligibility, 5, 83-84, 114 poverty thresholds, 38 state programs, 106, 114 see also Adults Agency for Health Care Policy and Research, 17, 52, 157-158, 163 Aid to Families with Dependent Children, 12, 88, 96, 97 see also TANF AIDS, see Human immunodeficiency virus Alcohol and drug abuse, see Substance abuse Alcohol tax, 104, 108 Allergies, 5, 120 Ambulatory care, see Emergency care; Outpatient care; Primary care Ambulatory Care Access Project, 47 American Academy of Pediatrics, 17, 55, 60 American Indians, see Native Americans Arizona, 79 Asians/Pacific Islanders, 27, 32-33, 34, 53-54 Assessment, see Accountability; Evaluation Asthma, 3, 5, 46, 48, 53, 115, 117, 124, 125, 166 Attitudes health beliefs, 25, 54 welfare recipients, embarrassment, 87-88, 104, 113 see also Health beliefs Auditory disabilities, see Hearing impairments B Balanced Budget Act of 1997, 38, 68, 72, 85, 98-99, 128, 167 see also SCHIP Behavioral disorders, 60, 98, 124, 128 Benchmark coverage, 61, 137, 140 Black persons, see African Americans Block grants, 2, 4, 14, 69, 75, 79, 124, 125, 127, 128-129 Blue Cross/Blue Shield, 103, 115, 116, 126, 137 Bureau of Primary Health Care Programs, 69 Buy-in, Medicaid, 98 See also Cost sharing; Sliding scale C California, 79, 103, 106, 109, 111, 115, 116, 117

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Cancer, 125, 126 Caring Programs, 25, 55, 103, 106, 107, 109, 116 Case management, 5, 60, 61, 72, 89, 91, 120, 125, 126, 129, 131, 132, 165 see also Coordination of care Catastrophic health insurance, 84, 108, 146, 148, 150 CHAMPUS, 25 Charity, see Safety net providers Child care (day care), 7, 20, 21, 129, 131 Child Health Plus, 106, 109, 111, 114 Children's Health Trust Fund, 2, 14 Children's hospitals, 1, 14, 67, 72, 75, 77, 131, 134 Children's Medical Security Plan, 110, 112-113 Chronic conditions, 5, 19, 22, 25, 55, 92, 108, 117, 120, 123-127, 131, 167 see also Special needs children; specific conditions Cigarette tax, see Tobacco tax Civilian Health and Medical Program of the Uniformed Services, see CHAMPUS Clinical assessments, 58, 75, 84, 92, 93, 133 Colorado, 106, 111, 115 Community health centers, 1, 124, 128, 136 AFDC population, 12 funding, 70, 72, 73-74 immunization, 12 Medicaid, 70, 72, 73 private insurers and, 73 safety net providers, 67, 70, 72, 73 Computer-based approaches, see Information technology Connecticut, 79, 137 Consumer protection, 21, 42, 99, 110, 155 see also Information infrastructure; Public education Continuity of care, 50, 55, 162 Coordination of care, 7, 20, 58, 60, 61, 96, 117, 118, 121, 125, 127, 129, 131, 132, 134, 137 see also Case management Copayments, 19, 51, 52, 103, 108, 110, 112, 113, 114, 129, 145 Cost and cost-benefit factors, 6, 18, 57, 120, 161 copayments, 19, 51, 52, 103, 108, 110, 112, 113, 114, 129, 145 federal preemption of state insurance laws, 147, 148 information technology, 133 inpatient care, 75 managed care, 4, 136 Medicaid, 4, 81-83 out-of-pocket expenses, 3, 6, 38, 52, 56, 105 preventive services (well care), 57, 120 safety net providers, 4, 68 severe/chronic medical conditions, 5 special needs children, 127-128, 129, 132, 136 state-sponsored programs, 109, 112, 114, 115, 147-148 tax credits, 153 tax subsidies, 16 treatment delays, 3, 23, 25, 38, 44, 56 uncompensated care, 68, 70, 71, 79, 114 Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89 uninsured persons, costs to, 146 see also Accountability Cost sharing, 5, 19, 34, 41, 42, 51, 52, 88, 99, 110, 113, 144, 145-146, 150 Cost-shifting, 3, 68 Counseling, 58, 59, 60, 78, 121, 124, 167 Crowd-out, see Substitution of coverage Cultural factors, access to care, 52, 53, 54, 129 language, 53, 54 safety net providers, 68 see also Health beliefs Culturally sensitive services, 3, 7, 54, 56 Current Population Survey, 2, 17, 25, 156, 157 D Data collection and dissemination, see Current Population Survey; Evaluation; Information infrastructure Deductibles, 19, 52, 127, 129, 145, 146, 148-152 (passim) Delaware, 111 Demographic factors educational attainment of parents, 34-37 federal data collection, 157-160; see also Current Population Survey rural areas, 54, 90 urban areas, 54, 115 see also Age factors; Families and households; Gender factors; Racial/ethnic factors; Socioeconomic status; specific racial/ethnic groups Dental health and services, 3, 44, 50, 90, 91, 108, 123, 156, 161, 166 Developmental disabilities, 124, 125, 134, 166 Diabetes mellitus, 5, 46, 120, 125, 167 Digestive system diseases, 122 Digital Equipment Corporation, 162, 164-165 Disabled persons definitions, legal, 125, 128, 130, 131 developmental disabilities, 124, 125 Medicaid, 13, 82, 84, 98, 99 private programs, 117 rehabilitative care, 55 SCHIP, Medicaid eligibility, 13 Supplemental Security Income, 128, 130 state benefits, 108 utilization rates, 21 see also Special needs children Diseases and disorders acute illness, 5, 22, 47, 55, 72, 120, 121-122, 124-126, 137 age factors, 121, 122 cost factors, general, 57 injuries, 3, 5, 19, 46, 55, 92, 120, 122, 125, 158, 166 see also Chronic conditions; Disabled persons; Special needs children; specific diseases, organs, and body systems Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89 Doctors, see Family physicians; Pediatric specialists; Physicians Drug-Free Schools and Communities Act, 79 Drugs, see Prescription medication; Substance abuse E Ear infections, 3, 5, 46, 56, 120, 161 Early and Periodic Screening, Diagnosis, and Treatment Program, see EPSDT

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  Economic factors employer-based insurance, development of, 143-145 see also Cost and cost-benefit factors; Funding; Market-based approaches; Poverty; Socioeconomic status Eczema, 5 Education, see Developmental disabilities; Health education; Public education; School-based clinics and insurance Educational attainment of parents, 34, 37 Eligibility, 4-5, 6, 12, 13, 14, 20, 83-86 Federal Poverty Level, employer-based insurance, eligibility, 34 family size, thresholds by, 38 Medicaid eligibility, 34, 81, 84, 85, 113 private insurers, eligibility, 116, 117 SCHIP eligibility, 13, 105, 106 state cost-sharing requirements, 42 state program eligibility, other, 110-114 (passim) HMOs, 165 Medicaid, 4-5, 12-14, 42, 80, 83-88, 90, 96-98, 99, 103, 104, 113, 127 age factors, 5, 83-84, 114 income thresholds, 5, 6, 13, 27, 79, 96, 150 SCHIP and, 5, 13, 20, 42 welfare and, 4-5, 12, 88, 89, 96-99 multiple programs, 7, 20 private programs, 116 SCHIP, 5, 6, 13, 20, 42, 88, 99, 105, 106, 118, 168 special needs/disabled children, 127-128, 131 state-sponsored programs, 5, 7, 86, 88, 103, 104-108, 110, 112-115 (passim), 168 Supplemental Security Income, 130, 131 tax credits, 153 see also Outreach Emergency care, 3, 51, 55, 68, 77, 112, 115, 117, 123, 159, 165 Emotional disturbances, see Special needs children Employer-based insurance, 2-3, 11, 18, 23, 34, 143-146, 158 access to care, 44, 46-51 age factors, 27, 30-31 employees, cost shifts to, 11 enrollment, 21, 25, 27, 143 federally mandated, 148-149, 151 HEDIS, 54, 156, 161-162 injuries, 46 Medicaid vs,27, 41, 149 parents, employed, with uninsured children, 23, 34, 35, 149 race/ethnicity, 27, 32-34 small employers, 34, 108, 110, 145(n.11), 148, 149 socioeconomic status and, 23, 34, 35, 149 poverty, 11, 35 state-sponsored programs, 38, 40, 105, 148-149, 158, 161 statistical trends, 24, 25-34, 41, 44, 46 substitution of coverage, 27, 41-42, 105 tax policy, 144, 145, 146, 151, 153(n.32) vouchers and, 150 Employment status parents, 23, 34-37, 105, 116, 143, 149 self-employed persons, 110, 145, 146, 149(n.23), 151-152 Encounter data, 21, 90, 94, 128, 156 Enrollment, 7, 20, 34, 42, 118 employer-based coverage, 21, 25, 27, 143 HEDIS data, 161 Medicaid, 3, 4-5, 13, 22, 25, 41, 50, 72, 79, 83-84, 87-88, 90, 93 , 94, 95, 98, 99, 128 private plans, 116, 117, 144-145 HMOs, 137, 164, 165 managed care, commercial, 21, 54, 72, 89, 93, 94, 99 racial factors, 41 SCHIP, 5, 6, 13, 21, 43, 79, 88, 168 state-sponsored programs, general, 5, 20, 42, 43, 72, 86-87, 104, 105, 110-115 (passim) Supplemental Security Income, 131 see also Outreach EPSDT, 50, 77, 81, 83, 84, 92-94, 127, 155-156 Evaluation, 5, 7, 20-21 clinical assessments, 58, 75, 84, 92, 93, 133 EPSDT, 156 managed care, 133 performance measures, 155, 156, 162-168 federal efforts, 157-160, 163, 167-168 HEDIS, 54, 156, 161-162 managed care, 54, 94 Medicaid, 94 private sector, 163-166 SCHIP, 6, 18, 21 special needs children, 127, 128 state programs, other, 112, 118, 167-168 SCHIP, 6, 18, 21 special needs children, programs, 21, 127, 128 see also Accountability; Information infrastructure Evidence-based approach, 2, 14, 16, 18, 167, 168 F Families and households, 34, 35-38, 52, 53, 136 emotionally disturbed children, 125 employer-based coverage, 18, 149, 151 single-parent families, 34-37, 152 see also Parents Family physicians, 121, 131, 164 Family planning, 58, 60, 61, 90, 91, 160 Federal government data sources, 2, 17, 156, 157-169 Current Population Survey, 2, 17, 25, 156, 157 employer-based coverage, mandated, 148-149, 151 Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89 funding, 2, 4, 68 community health care centers, 70 local services, 68 matching funds, 12, 13, 68, 84, 90, 103 SCHIP, 13, 42, 79-80, 85, 108 school-based centers, 79 special needs children, 127, 128 see also Block grants performance measures, 157-160, 163, 167-168 preemption of state insurance laws, 147-148 public health departments, 76 safety net providers, 68, 70, 74 state cooperation with, general, 14, 147-148, 167 tax policy, 1, 14, 22, 108, 116, 144, 145, 146, 149(n.32), 150-154

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  vouchers, 2, 14, 22, 149-150, 153 see also Legislation; Medicaid; Medicare; SCHIP; specific agencies Federal Poverty Level (FPL) employer-based insurance, eligibility, 34 family size, thresholds by, 38 Medicaid eligibility, 34, 81, 84, 85, 113 private insurers, eligibility, 116-117 SCHIP eligibility, 13, 105, 106 state cost-sharing requirements, 42 state program eligibility, other, 110, 114 (passim) Firewalls, 42, 114 Florida, 79, 106-112 Food aid, see Nutrition Food Stamp program, 97, 149 Foundation for Accountability, 162, 166 Funding community health centers, 70, 72, 73-74 federal, 2, 4, 68 community health care centers, 70 local services, 68 matching funds, 12, 13, 68, 84, 90, 103 SCHIP, 13, 42, 79-80, 85, 108 school-based centers, 79 special needs children, 127, 128 Medicaid, 83, 85, 90 mental health services, 124 patchwork, 25, 77 public health departments, 78 safety net providers, 68-70, 72, 73, 74, 79-80 SCHIP, 13, 79-80, 85, 108 school-based health centers, 79 state programs, 2, 13, 79-80, 85, 108, 110, 112, 113, 114 copayments, 103, 108, 110, 112, 113, 114 premiums, 104, 108, 110, 112, 113, 114, 116 Supplemental Nutrition Program for Women, Infants, and Children, 69, 78, 129 see also Balanced Budget Act of 1997; Block grants; Personal Responsibility and Work Opportunity Reconciliation Act of 1996 The Future of Public Health,75 G Gender factors emergency room visits, 51 single-parent families, 35, 36, 37 Georgia, 115 Government role, see Federal government; Local government; State government H Hawaii, 106, 109, 111, 148 Health beliefs Hispanics, 53 parental, 25 Southeast Asians, 54 Health Care Financing Administration, 25, 94, 155, 157 Health education, 20, 21, 58, 61, 93, 115, 117, 121, 129, 133, 134 , 162, 165 counseling, 58, 59, 60, 78, 121, 167 Health insurance, general, 1-2, 13-14, 16, 17, 136-137 access to care and, 46-51 African Americans, 3, 27, 32-33 age factors, 21, 27, 30-31 Asians/Pacific Islanders, 27, 32-33, 34 catastrophic, 84, 108, 146, 148, 150 copayments, 19, 51, 52, 103, 108, 110, 112, 113, 114, 129, 145 deductibles, 19, 52, 127, 129, 145, 146, 148-152 (passim) entitlement to, 6, 19 Hispanics, 3, 27 information infrastructure, 20-21, 22, 25-27, 155-163 market-based approaches, 143-154 risk adjustment, 123, 136, 145 risk pools, 110 standards, benefits, 3, 5, 58, 60, 91, 92, 99, 133, 148-150 benchmark coverage, 61, 137, 140 Healthy People 2000,166-167 HMOs, 162-165 see also Eligibility; Employer-based insurance; Enrollment; Medicaid; Medicare; Premiums; Private health insurance; SCHIP; Tax policy; Uninsured adults; Uninsured children Health Insurance Portability and Accountability Act of 1996, 133 Health maintenance organizations, 133, 136, 137 Digital Equipment Corporation, 162, 164-165 Health Partner, 127 Health plan Employer Data Information System, see HEDIS Health Resources and Services Administration, see Maternal and Child Health Care Services Block Grant Health Security Act, 148 Health services, availability and access, 1, 2, 3, 11, 13-14, 16, 17, 23, 25, 44-61, 120-139 African Americans, 41, 49, 51, 53, 54 age factors, 44 continuity of care, 50, 55, 162 cultural factors, 52, 53-54, 129 culturally sensitive services, 3, 7, 54, 56 safety net providers, 68 defined, 44, 55 equipment, 5, 58, 60, 61, 120, 128, 129, 130, 131, 132, 136 financial barriers, 44-52; see also Employment status; Poverty; Socioeconomic status framework for, 45 Hispanics, 32-33, 41, 53 managed care, 54-55, 79, 133, 136 military health care, 24, 26 nonfinancial barriers, 7, 20, 45, 53, 129-132, 136 child care (day care), 7, 20, 21, 129, 131 embarrassment, 87-88, 104, 113 health beliefs, 23, 54 parental education, 34-37, 52 transportation, 5, 7, 20, 21, 53, 67, 129, 132, 136 see also Administrative barriers outpatient care, 3, 47, 53, 56, 58, 75, 77, 90, 112, 114, 116, 159 poverty and, general, 34, 47, 48, 52, 53, 56, 67, 83, 123, 133, 136, 166 primary care, 1, 5, 14, 34, 47, 118, 121, 124, 125, 132, 164, 165, 167 racial/ethnic factors, 44, 47, 49, 51, 52, 53-54, 129

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  see also Coordination of care; Safety net providers; Uninsured adults; Uninsured children; specific providers and services Health Services for Children With Special Needs, 127 Health status, general, 5-6, 120-139 adults vs children, 19, 136, 151, 164 parental, 53 poverty and, 47 risk pools, 110 see also Diseases and disorders; Special needs children; specificdiseases, organs, and body systems Healthy Kids, 106, 109, 110, 112 Healthy People 2000,78, 123, 128, 162, 166-167 Hearing impairments, 3, 56, 93, 112, 125 Heart disease, 5, 90, 119, 124, 125, 126 HEDIS, 54, 156, 161-162 Hispanics access to care, 32-33, 41, 53 health beliefs, 53 insurance coverage, 3, 27 HIV, see Human immunodeficiency virus HMOs, see Health maintenance organizations Home health care, 67, 75, 90, 115, 158 Homeless persons, 67, 68 Hospitals and hospitalization, 1, 46-48, 116, 159 asthmatics, 53 children's hospitals, 1, 14, 67, 72, 75-77, 131, 134 developmentally disabled children, 125 length of stay, 77 poor persons, 47, 53, 61, 68, 70, 77, 89 rehabilitation, 58, 60, 72, 75, 76 safety net services, 68, 72, 75, 76 Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89 state programs, 108, 112, 113, 114, 115, 116 see also Emergency care Human immunodeficiency virus, 5, 115, 120, 128-129 I Immunization, 3, 5, 12, 47, 49, 55, 59, 69, 78, 93, 112, 115, 120, 125, 133, 136, 137, 161, 165, 167 public health departments, 12, 133, 136 Income, see Poverty; Socioeconomic status Indemnity insurance, 1, 54, 126 Indians (American), see Native Americans Infectious and parasitic diseases, 3, 48, 49, 121, 122, 167 see also Immunization; specific diseases Information infrastructure, 20-21, 22, 155-163, 165 coverage estimates, 25-27 federal data sources, 2, 17, 156, 157, 169 Current Population Survey, 2, 17, 25, 156, 157 HEDIS, 54, 156, 161-162 standards for data, 10, 133, 156-161 study at hand, 17 see Current Population Survey; Health education Information technology, 20, 133, 134, 135, 161, 165, 168 federal vs private software, 156 Internet, 156 proprietary information, 156 telemedicine, 91, 133 Injuries, 3, 5, 19, 46, 55, 92, 120, 122, 125, 158, 166 Internal Revenue Service, 144, 150, 151, 152 Internet, 133, 134-135, 156, 165 Iowa, 106, 109, 116 J Joint Commission on Accreditation of Health care Organizations, 161-162, 166 K Kaiser Permanente, 116-117 Kansas, 106, 109, 116 L Language factors, 53, 54 Legislation, 22, 96-99 Balanced Budget Act of 1997, 12, 38, 68, 72, 85, 98-99, 128, 167; see also SCHIP Drug-Free Schools and Communities Act, 79 Health Insurance Portability and Accountability Act of 1996, 133 Health Security Act, 148 history of Medicaid legislation, 84, 85 Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991, 85 Medicare Catastrophic Coverage Act of 1988, 84 Omnibus Budget Reconciliation Acts, 84, 85, 155-156 Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 12, 85, 96, 125, 131 preemption of state insurance laws, federal, 147-148 Public Health Service Act, 70, 128 safety net providers, 68 Social Security Act of 1965, 13, 69, 75, 84; see also listings under ''Social Security Act of 1965" Tax Payer Relief Act of 1997, 151 Length of stay, 77 Local factors special needs children, 127, 136 state programs responsive to, 104 racial/ethnic factors, 34 see also Community health centers Local government community health centers, funding, 70, 72 public health departments, 77, 78 special needs children, 127 Low-income persons, see Poverty M Maine, 103 Managed care, 4, 137 access issues, 54-55, 79, 133, 136 AFDC population, 12 cost and cost-effectiveness, 4, 136

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  encounter data, 90, 94, 128, 156 enrollment, commercial providers, 21, 54, 72, 89, 93, 94, 99 HMOs, 137, 164, 165 HMOs, 133, 136, 137, 162, 164-165 Medicaid, 4, 11, 12-13, 68, 72, 83, 89, 94-96, 98-99, 128, 137 performance measures, 54, 94 primary care, 126, 131, 136, 164 public health departments, 78-79 state programs, 5, 102-104, 107, 112, 113, 115, 133, 136 Market-based approaches, 4, 11, 12, 72, 79, 89, 94, 104, 114, 143-154 see also Tax policy Maryland, 79 Massachusetts, 79, 103, 105, 106, 109, 110, 111, 112-113, 137 Maternal and Child Health Care Services Block Grant (Title V, SSA) , 4, 69, 75, 79, 127, 128, 129 MCOs, see Managed care Media, 2, 15 Medica, 117 Medicaid (Title XIX, SSA), 2-5, 6, 21, 23, 27, 28, 34, 36, 81-99, 116, 136-137 access to care, 44, 46-51 accountability, 89-90, 94 administrative barriers, 87-88, 103, 113, 115, 150 age factors, 27, 30-31, 41 buy-in, 98 community health centers, 70, 72, 73 coverage estimates, 24-33, 36, 81, 83 disabled persons, 13, 82, 84, 98, 99 EPSDT, 77, 78, 81, 83, 84, 92-94 eligibility, 4-5, 12-14, 42, 80, 83-88, 90, 96-98, 99, 103, 104, 113, 127 age factors, 5, 83-84, 114 income thresholds, 5, 6, 13, 27, 79, 96, 150 SCHIP and, 5, 13, 20, 13, 42 welfare and, 4-5, 12, 88, 89, 96-99 employer-based insurance vs, 27, 41, 149 enrollment, 3, 4-5, 13, 22, 25, 41, 50, 72, 79, 83-84, 87-88, 90, 93, 94, 95, 98, 99, 128 evaluation, 21 funding, 83, 85, 90 history, 81-83, 84-85 injuries, 46 litigation by beneficiaries, 168 managed care, 4, 11, 12-13, 68, 72, 83, 89, 94-96, 98-99, 128, 137 primary care, 83, 117 public health departments, 78 race/ethnicity, 27-28, 32-34, 41 safety net providers, 4, 12-13, 67, 68, 69, 70, 72, 73, 77, 78, 79 SCHIP and, 2, 5, 6, 12, 13, 20, 42, 61, 83, 102, 107, 137 school-based health centers, 79 special needs children, 127-128, 136 state programs, 2, 3, 11, 83, 85, 86, 90, 93, 96, 98-99, 102-104, 107, 112, 113, 115, 137 substitution of coverage, 27, 41-42, 105-108 welfare delinking, 4-5, 12, 89, 96-98 see also Disproportionate Share Hospital payments; Medicaid; Medicare Medicaid Data System, 157 Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991, 85 Medi-Cal, 116-117 Medical equipment, 5, 58, 60, 61, 120, 128, 129, 130, 131, 132, 136 Medical Expenditure Panel Survey, 157 Medical home, see Usual source of care Medical Savings Accounts, 2, 14 Medicare community health centers, 70, 73 safety net providers, 67, 69 statistical trends, 24, 25, 26 Medicare Catastrophic Coverage Act of 1988, 84 Mental health and illness, 123, 124, 125, 127, 131, 137, 166 behavioral disorders, 60, 98, 124, 128 school-based care, 79 state benefits, 108, 112, 137 substance abuse, 115, 123, 124-125, 127, 166 Mercy Health Plan, 117 Michigan, 79, 103, 106, 109, 117 Military health care, 24, 25, 26 Minnesota, 103, 106, 109, 110, 111 Minority groups, see Racial/ethnic factors; specific groups Missouri, 116 Montana, 103, 106, 109, 116 N National Ambulatory Medical Care Survey, 157 National Association of Children's Hospitals and Related Institutions , 75, 77 National Cancer Institute, 126 National Center for Health Statistics, 44 National Committee for Quality Assurance, 161, 166 National Employer Health Insurance Survey, 159 National Forum on the Future of Children and Families, 58 National Health and Nutrition Examination Survey, 158 National Health Interview Survey, 158 National Health Provider Inventory, 158 National Home and Hospice Care Survey, 158 National Hospital Ambulatory Medical Care Survey, 159 National Hospital Discharge Survey, 159 National Immunization Survey, 159 National Institute of Mental Health, 124 National Medical Expenditure Survey, 34, 46, 146 National Nursing Home Survey, 159 National Survey of Ambulatory Surgery, 159 National Survey of Family Growth, 160 National Vital Statistics System, 160 Native Americans, 27 Neural system disorders, 5, 120, 125, 134-135 New Hampshire, 103, 106, 109 New Jersey, 103, 105, 109, 111 New York State, 79, 103, 106, 109, 111 North Carolina, 106, 109, 115, 116 Nurses and nursing services, 58, 60, 61, 75, 79, 90, 91, 115, 123, 127, 131, 132 Nutrition, 69, 78, 121, 125, 135, 158, 166 Food Stamps, 97, 149 O Ohio, 115, 117 Omnibus Budget Reconciliation Acts (OBRA), 84, 85, 155-156

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OmniCare Health Plan, 117 Oregon, 111 Organ transplants, 112 Outcome measures, see Performance measures Out-of-pocket expenses, 3, 6, 38, 52, 56, 105, 113 special needs children, 127, 129, 132, 136 see also Copayments; Deductibles; Premiums Outpatient care, 3, 47, 53, 56, 58, 75, 77, 90, 112, 114, 116, 159 see also Emergency care Outreach, 7, 20, 34, 53, 88, 104, 110, 116 see also Public education P Pacific Business Group on Health, 162 Pacific Islanders, see Asians/Pacific Islanders Parents, 25, 34-37, 52-53 educational attainment, 34-37, 52 employment status, 23, 34-37, 105, 116, 143, 149 single-parent families, 34-37, 152 skills training, 121 special needs children, 121, 126, 127 tax policy, 151 uninsured, 107, 151 Patient education, see Health education Pediatric specialists, 5, 14, 54, 55, 58, 74, 75, 76, 90, 96, 99, 112, 118, 120, 121, 123, 124, 126, 131-136 (passim), 164 American Academy of Pediatrics, 17, 55, 60 Pennsylvania, 79, 103, 106, 109, 111, 116 Performance measures, 155, 156, 162, 168 federal efforts, 157-160, 163, 167, 168 HEDIS, 54, 156, 161-162 managed care, 54, 94 Medicaid, 94 private sector, 163-166 SCHIP, 6, 18, 21 special needs children, 127, 128 state programs, other, 112, 118, 167-168 see also Accountability Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 12, 85, 96, 125, 131 Pharyngitis, 46 Physicians, 90, 129, 158 access to, 3, 46, 50, 52, 53, 54, 61 chronic conditions, treatment, 5 minority physicians, 53 state benefits, 112, 137 see also Pediatric specialists Political factors, 2, 14, 99, 147-148 Poverty access to care, 34, 47, 48, 52, 53, 56, 67, 83, 123, 133, 136, 166 community health centers, 72 disabled children, 127 employer-based insurance and, 11, 35 Federal Poverty Level employer-based insurance, eligibility, 34 family size, thresholds by, 38 Medicaid eligibility, 34, 81, 84, 85, 113 private insurers, eligibility, 116, 117 SCHIP eligibility, 13, 105, 106 state cost-sharing requirements, 42 state program eligibility, other, 110-114 (passim) hospitalization, 47, 53, 61, 68, 70, 77, 89 nonfinancial barriers to access, 45, 53 preventive care, 3, 47, 133, 136 private insurers, 99, 116-117 providers serving poor persons, 3 SCHIP, 2, 13 Federal Poverty Level and, 13, 105, 106 special needs children, 127, 130 state programs, general, 5, 20, 99, 103-115 (passim) subsidies, 4, 79, 103, 104, 150, 153 substitution of coverage, 41-42, 106 uninsured persons, 2, 7, 13, 37, 47, 70, 83, 89-90 see also Safety net providers; Welfare Premiums, 145, 146 private insurers, 117 state-level actions, 104, 108, 110, 112, 113, 114, 116 Prescription medication, 44, 112, 117, 195 Preventive care (well care), 5, 19, 47, 53, 55, 57-59, 120, 121, 128, 133, 161 cost factors, 57, 120 counseling, 58, 59, 60, 78, 121, 124, 167 dental, 50 EPSDT, 77, 78, 81, 83, 84, 92-94 family planning, 58, 60, 61, 90, 91, 160 federal role, 148 Healthy People 2000,78, 123, 128, 162, 166-167 poor persons, general, 3, 47, 133, 136 private insurers, 115, 116, 164, 165 safety net providers, 68, 78 standards, 3, 148 state programs, 104, 113, 114, 137 utilization rates, 21 see also Immunization Preventive Health Block Grant, 79 Primary care, 120, 124, 131 access/use, 1, 5, 14, 34, 47, 118, 121, 124, 125, 132, 164, 165, 167 HEDIS, 161 managed care, 126, 131, 136, 164 Medicaid, 83, 117 private insurers, 116, 117, 164, 165 safety net providers, 4, 67, 68, 70, 79 state programs, 112-115 (passim) Private health insurance, 2, 4, 5, 6, 18, 21-22, 24, 26, 115-118, 137, 144-145 Blue Cross/Blue Shield, 103, 115, 116, 126, 137 community health centers, 73 enrollment, 116, 117, 144-145 managed care, commercial, 21, 54, 72, 89, 93, 94, 99 HMOs, 137, 164, 165 Kaiser Permanente, 116-117 Medicaid, reimbursement vs, 4, 11 need-based approach, 19-20 performance measures, 163-166 HEDIS, 54, 156, 161-162 poor persons, 99, 116-117 preventive care, 115, 116, 164, 165 primary care, 116, 117, 164, 165 regional coverage patterns, 38, 40 special needs children, 126-127 state-level actions, 2, 5, 6, 38, 40, 102, 103-104, 115-117 substitution of coverage, 107 see also Employer-based insurance; Health maintenance organizations; Self-pay insurance

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  Public assistance, see Medicare; Welfare Public education, 88, 98, 116, 118, 127 see also Outreach Public health departments immunization, 12, 133, 136 safety net providers, 67, 68, 75, 77, 79 special needs children, 55 Public health mission, 75, 104 Public Health Service Act, 70, 128 Public insurance international comparisons, 23 see also Medicaid; Medicare R Racial/ethnic factors, 21, 156 access to care, 44, 47, 49, 51, 52, 53-54, 129 coverage/utilization rates, 21, 27, 32-34 emergency room visits, 51 enrollment, 41 Medicaid, 27-28, 32-34, 41 Regional factors coverage levels, 38, 40 private insurers, 38, 40 special needs children, costs, 127 specialty centers, 75 Rehabilitation services, 58, 60, 72, 75, 76, 112 Reimbursement rates for providers, 4, 5, 34, 70, 72, 89, 156 Research methodology data collection, 156 evidenced-based approach, 2, 14, 16, 18, 167, 168 funding streams, 25 report at hand, 1-2, 13-14, 16, 17 substitution of coverage, 27, 42 see also Evaluation Respiratory diseases, 5, 48, 120, 121, 122, 124, 125 asthma, 3, 5, 46, 48, 53, 115, 117, 124, 125, 166 Rhode Island, 106, 109 Risk adjustment, 123, 136, 145 Risk pools, 110 Rural areas, 54, 90 S Safety net providers, 4, 12, 67-80 community health centers, 67, 70, 72, 73 cost factors, 4, 68 cultural factors, 68 defined, 67-68 Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89 federal role, general, 68, 70, 74 funding, 68-70, 72, 73-74, 79-80 hospitalization, 68, 72, 75, 76 Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89 institutional vs individual approach, 18 Medicaid, 4, 12-13, 67, 68, 69, 70, 72, 73, 77, 78, 79 Medicare, 67, 69 medium-income persons, provisions for, 42, 108, 112, 132 preventive care, 68, 78 primary care, 4, 67, 68, 70, 79 public health departments, 67, 68, 75, 77-79 SCHIP, 6, 70, 79-80 school-based programs, 67, 77, 78, 79 state-based programs, 68, 70, 72, 77, 78, 79 study methodology, 1, 14 subsidies, 4, 68, 70, 79 transportation, 67 welfare-Medicaid delinking, impact on, 12, 89, 96 see also specific providers SCHIP (Title XXI, SSA), 2, 5, 6, 12, 13, 14, 18, 40, 61, 99, 102, 107, 110, 112, 118, 137, 168 accountability, 2, 14, 18, 42, 105, 118, 168 adults, 70 disabled persons, 13 eligibility, 5, 6, 13, 20, 42, 88, 99, 105, 106, 118, 168 enrollment, 5, 6, 13, 21, 43, 79, 88, 168 evaluation, 6, 18, 21 funding, 13, 42, 79-80, 85, 108 managed care and, 99 Medicaid and, 2, 5, 6, 12, 13, 20, 42, 61, 83, 102, 107, 137 outreach, 88 poverty, 2, 13 federal poverty level and, 13, 105, 106 performance measures, 6, 18, 21 safety net providers, 6, 70, 79-80 subsidies, 6, 118 substitution of coverage, 27, 41-42, 105-108 School-based clinics and insurance private insurers, 115, 117 safety net providers, 67, 77, 78, 79 special needs children, 5-6, 136 state programs, 79, 112 School Lunch Program, 112 Self-employed persons, 110, 145, 146, 149(n.23), 151-152 Self-pay insurance, 145(n.11), 151 state incentives, 110 statistical trends, 24, 26 see also Vouchers Sickle cell disease, 5, 120, 125 Single-parent families, 34-37, 152 Sliding scale, 70, 103, 110, 112-113 Small employers, 34, 108, 110, 145(n.11)(n.11), 148, 149 Social Security Act of 1965 Title V, see Maternal and Child Health Care Services Block Grant Title XVI, see Supplemental Security Income Program Title XIX, see Medicaid Title XXI, see SCHIP Socioeconomic status, 23, 34-37 access to care, 44, 48-49 medium-income persons, provisions for, 42, 108, 112, 132 state coverage, 42, 105-107, 110, 113, 114 see also Current Population Survey; Poverty Southeast Asians, 53-54 Specialists and special care centers, 21, 55, 72, 75, 91, 112, 125, 126, 131, 133 see also Pediatric specialists; Rehabilitation services Special needs children, 5-6, 19, 55, 58, 59, 75, 98, 120-121, 124-132 administrative barriers to access, 127 cost factors, 127-128, 129, 132, 136 out-of-pocket expenses, 127, 129, 132, 136 eligibility, 127-128, 131 evaluation of services, 21, 127, 128 federal funding, 127, 128 local factors, 127 managed care, 54-55 Medicaid, 127-128, 136 parents of, 121, 126, 127 performance measures, 127, 128 poor, 127, 130

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  private insurers, 126-127 public coverage, 127-129 school-based programs, 5-6, 136 state-level factors, 127-128 state programs, 127, 133, 136, 137 transportation, 5, 129, 132, 136 treatment delays, 25 see also Chronic conditions; Disabled persons; specific conditions Standards data collection, 10, 133, 156-161 EPSDT, 92, 93 health care benefits, 3, 5, 58, 60, 91, 92, 99, 133, 148-150 benchmark coverage, 61, 137, 140 Healthy People 2000, 166-167 HMOs, 162-165 preventive services, 3, 58, 148 state reimbursement rates, 72 see also Eligibility State Children's Health Insurance Program, see SCHIP State government, 5, 21-22, 102-115, 118, 137, 162 age factors, coverage, 106, 114 community health centers, 70, 72 cost factors, 109, 112, 114, 115, 147-148 disabled persons, 108 eligibility, insurance, 5, 7, 86, 88, 103, 104-108, 110, 112-115 (passim), 168 employer-based insurance, 38, 40, 105, 148-149, 158, 161 enrollment, insurance, 5, 20, 42, 43, 72, 86-87, 104, 105, 110-115 (passim) evaluation, 112, 118, 167-168 federal cooperation with, general, 14, 147-149, 167 Federal Poverty Level state cost-sharing requirements, 42 state program eligibility, other, 110-114 (passim) federal preemption of state insurance laws, 147-148 funding, 2, 13, 79-80, 85, 108, 110, 112, 113, 114 copayments, 103, 108, 110, 112, 113, 114 premiums, 104, 108, 110, 112, 113, 114, 116 hospitalization, 108, 112, 113, 114, 115, 116 managed care plans, 5, 102-104, 107, 112, 113, 115, 133, 136 Medicaid, 2, 3, 11, 83, 85, 86, 90, 93, 96, 98-99, 102-104, 107, 112, 113, 115, 137 medium-income persons, provisions for, 42, 108, 112, 132 mental health services, 108, 112, 137 multiple programs, eligibility differences, 20 performance measures, 112, 118, 167-168 physician benefits, 112, 137 poor persons, general, 5, 20, 99, 103-115 (passim) premiums, 104, 108, 110, 112, 113, 114, 116 preventive care, 104, 113, 114, 137 primary care, 112-115 (passim) private insurers, use of, 2, 5, 6, 38, 40, 102, 103-104, 115-117 public health departments, 77, 78 safety net providers, 68, 70, 72, 77, 78, 79 school-based health centers, 79, 112 scope of benefits, 108, 109, 112-115 self-pay insurance, 110 socioeconomic status and, 42, 105, 107, 110, 113, 114 special needs children, 127, 133, 136, 137 subsidies, 5, 42, 99, 101-115 (passim), 118, 121, 148 see also SCHIP State-level factors, 102-115 coverage levels, 38, 40 employer-based insurance, 38, 40, 105, 148-149, 158, 161 private insurers, 2, 5, 6, 38, 40, 102, 103-104, 115-117 racial/ethnic factors, 34 school-based care, 79 special needs children, 127-128 uninsured persons, 3, 38, 40, 113, 115, 116, 117 see also specific states Statistical programs and activities, see Information infrastructure Subsidies, 11 adults, 111, 121, 151 employer-provided insurance, federal subsidies, 149 Medicaid, 99, 102-104, 107, 112, 113, 118 nonmedical, adjunct services, 21 poor persons, 4, 79, 103, 104, 150, 153 private insurers, 116, 117, 148 safety net providers, 4, 68, 70, 79 SCHIP, 6, 118 state programs, 5, 42, 99, 101-115 (passim), 118, 148 tax policy and, 16, 144, 145, 146, 149-153 see also Vouchers Substance abuse, 115, 123, 124-125, 127, 166 Substance Abuse and Mental Health Services Administration, 124 Substitution of coverage, 27, 41-42, 105-108 Supplemental Nutrition Program for Women, Infants, and Children funding , 69, 78, 129 Supplemental Security Income Program (Title XVI, SSA), 84, 98, 128 , 130-131 eligibility, 130, 131 Survey of Income and Program Participation, 34, 160 Systems of Accountability: Implementing Children's Health Insurance Programs, 2, 14 T TANF, 96, 97 Tax Payer Relief Act of 1997, 151 Tax policy, 22, 108, 150-154 alcohol tax, 104, 108 credits, 152-154 for children, 2, 14 for self-insured individuals, 110 for small employers, 110 deductions, 151-152 employer-provided insurance, 144, 145, 146, 151, 153(n.32) self-employed persons, 145, 146, 149(n.23), 151-152 health service providers, 114 IRS role, 144, 150-151, 152 Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991, 85 parents, 151 refundable family credits, 2, 14 social security tax, 108 subsidies, general, 16, 144, 145, 146, 149-153 tobacco tax, 113, 116 uninsured, impact on, 150 Telemedicine, 91, 133

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Temporal factors caregivers' time costs, 132 data collection, 156 HMO appointments, 164 hospitals, length of stay, 77 private insurance, 137 treatment delays, 3, 23, 25, 38, 44, 54, 56 uninsured status, duration, 34, 38, 39, 107 waiting periods, 114 Temporary Assistance to Needy Families (TANF), 96, 97 Tennessee, 106, 109, 110-112, 115 Texas, 79 Title V (Social Security Act), see Maternal and Child Health Care Services Block Grant Title XVI (Social Security Act), see Supplemental Security Income Program Title XIX (Social Security Act), see Medicaid Title XXI (Social Security Act), see SCHIP Tobacco tax, 104, 108, 113, 116 Transportation, 7, 20, 21, 53 safety net providers, 67 special needs children, 5, 129, 132, 136 U Uncompensated care, 68, 70, 71, 79, 114 Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89 UniHealth, 117 Uninsured adults, 4, 24, 26, 27, 68, 70 parents, 107, 151 see also Safety net providers; SCHIP Uninsured children, 2, 7, 13, 16, 23, 24, 34, 42, 83, 89-90 access to care, 44, 46-52, 56, 146 age factors, 27, 30-31, 41 community health centers, 73 employed parents with, 23, 34, 149 extent of, 3, 11, 23-33, 41, 70 race/ethnicity, 27, 41 school-based health centers, 79 state/regional patterns, 3, 38, 40, 113, 115, 116, 117 study methodology, 1 temporal factors, duration, 34, 38, 39, 107 waiting periods, 114 see also Safety net providers; SCHIP United Health Care of Ohio, 117 Urban areas, 54, 115 U.S. Preventive Services Task Force, 59 Usual source of care, 47, 50, 52, 121 V Vaccination, see Immunization Vermont, 103, 106, 109, 111 Visual impairments, 59, 61, 84, 93, 112, 117, 125, 130, 133, 137 Vouchers, 2, 14, 22, 149-150, 153 W Washington, 103, 106, 109, 110, 111, 128 Welfare IRS, involvement in, 150-151 legislative reforms, 96-99 Medicaid, delinking, 4-5, 12, 89, 96-98 tax policy and, 146 see also Aid to Families with Dependent Children; Medicaid; Personal Responsibility and Work Opportunity Reconciliation Act of 1996; Safety net providers; Supplemental Nutrition Program for Women, Infants, and Children; Supplemental Security Income Program; Temporary Assistanceto Needy Families Well care, see Preventive care White persons, 32-33, 54 emergency care, 51 immunization, 49 Women, Infants, and Children Program, see Supplemental Nutrition Program for Women, Infants, and Children Wyoming, 103 Z ZAP Asthma, 127