Between 1983-1998, 5.4 million children and adolescents were admitted to California hospitals. During these years, large segments of the Medicaid population transitioned into managed care, welfare reform was implemented, children's insurance coverage shifted through the Title XXI State Child Health Insurance Program, and many businesses downsized and eliminated employee's dependent benefits. These public initiatives were instituted without efforts to monitor the impact of these changes on the health and well being of poor children who are most likely to be effected. OBJECTIVES: To describe population-based changes that occurred in children's access to hospital care and to evaluate the policy implications of these changes. METHODS: Hospital discharge files for 1983-1998 were searched to identify California residents age 30 days to 19 years who were hospitalized. Discharge records were summarized within year and merged with population files to calculate rates. RESULTS: Child admissions decreased over the study period. Population rates decreased least for age 0 to 4, with an erratic pattern for this group after 1994. In all ages, most decrease occurred among White and Asian children. Population-based admission rates based on payor source decreased 16% for poor children and 67% for children with private (HMO/PPO/FFS) coverage. Hospital rates for emergency room admissions, complications of care, and non-routine dispositions increased. CONCLUSIONS: Basic indicators one might use to conclude that access to primary care had improved as a result of Medicaid and managed care expansions were incompatible with that expectation for poor children and children of color.
Learning Objectives: 1. Describe population-based changes that occurred in children's access to hospital care between 1983 and 1998. 2. Evaluate the policy implications of these changes
Keywords: Children's Health, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.