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Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
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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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
×

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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
×

 

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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
×

 

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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
×

 

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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
×

 

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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
×

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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
×

 

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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
×

 

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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
×

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

Suggested Citation:"Index." Institute of Medicine. 1998. America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press. doi: 10.17226/6168.
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America's Children: Health Insurance and Access to Care Get This Book
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America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population?

America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of "safety net" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance.

In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.

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