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OVERVIEW

OVERVIEW. Ambulatory Health Care Use by Children Prevalence/Service Use of Children With Chronic Illness Special Health Care Needs Among Low-Income, Uninsured Children Implications for Benefit Package Design Under CHIP. AMBULATORY HEALTH CARE VISITS. NCHS, 1998.

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OVERVIEW

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  1. OVERVIEW • Ambulatory Health Care Use by Children • Prevalence/Service Use of Children With Chronic Illness • Special Health Care Needs Among Low-Income, Uninsured Children • Implications for Benefit Package Design Under CHIP

  2. AMBULATORY HEALTH CARE VISITS NCHS, 1998

  3. AMBULATORY VISITS AMONG CHILDREN UNDER AGE 1, BY PRINCIPAL DIAGNOSIS NCHS, 1998

  4. CHRONIC CHILDHOOD ILLNESS: PREVALENCE, SEVERITY, IMPACT Children affected by a chronic condition……………….31% Highly prevalent conditions include: Respiratory allergies Repeated ear infections Asthma NHIS data, Newacheck and Taylor, 1992

  5. PERCENTAGE DISTRIBUTION OF CHILDREN WITH CHRONIC CONDITIONS, BY SEVERITY LEVEL Mild……………………………66% Moderate……………...……….29% Severe…………………..……….5% NHIS data, Newacheck and Taylor, 1992

  6. DISABILITY AMONG UNINSURED CHILDREN IN LOW INCOME FAMILIES 1994 NHIS data, Maternal & Child Health Policy Research Center

  7. CHRONIC CONDITIONS, SPECIAL NEEDS, AND DISABILITY FOR CHILDREN UNDER 18 YEARS OLD

  8. SPECIAL HEALTH CARE NEEDS AMONG UNINSURED CHILDREN IN LOW INCOME FAMILIES Source: Newacheck et al. March 1998

  9. PREVALENCE OF CHILDREN WITH A DISABILITY, BY AGE SIPP data, CDC, 1995

  10. SERVICE UTILIZATION BY CHILDREN WITH CHRONIC CONDITIONS The 5 % With Severe Conditions Accounted For: • 19% of Physician Contacts • 33% of Hospital Days NHIS data, Newacheck and Taylor, 1992

  11. COVERING A CONTINUUM OF CARE FOR CHILDREN Preventive Primary Acute Specialty Ancillary/Support

  12. THINK BEYOND THE BENEFITS PACKAGE • Medical Necessity • Provider Network Requirements • Relationships Between MCOs and Other Agencies/Programs • Contracting With MCOs

  13. SUMMARY POINTS • Children Need a Range of Services • You Don’t Need to Reinvent the Wheel • Make Sure the Benefits Children Need Are Available--Be Creative!

  14. BENEFITS ADDITIONAL-CATEGORIES

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