Evaluation of the Arizona health care cost-containment system.

This article evaluates Arizona's alternative to the acute portion of Medicaid, the Arizona Health Care Cost-Containment System (AHCCCS), during its first 18 months of operation from October 1982 through March 1984. It focuses on the program's implementation and describes and evaluates the program's innovative features. The features of the program outlined in the original AHCCCS legislation included: Competitive bidding, prepaid capitation of providers, capitation of the State by the Health Care Financing Administration, assignment of gatekeepers, beneficiary copayment, private administration, inclusion of private and public employees and county financed long-term care. An assessment of implementation during the second 18 months of the program reporting on more recent developments and is now being prepared by SRI International.     

Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents

Purpose: To describe and differentiate the usual sources of health care, patterns of utilization of services, and reasons for foregone health care among Hispanic adolescents by place of birth (U.S. mainland versus Puerto Rico or other country) and gender.

Methods: All subjects who identified themselves as Hispanic (n = 717) in a larger survey of 10,059 students in 7th (n = 3596), 9th (n = 3691), and 11th (n = 2772) grades in the state of Connecticut in 1996 were included in this secondary analysis. Data were analyzed using Pearson product-moment coefficients, Chi-squares, and logistic regression.

Results: The majority of usual sources of medical care services were community clinics or private doctors’ offices. Subjects born in Puerto Rico or countries other than the United States were more likely to use a doctor’s office. About 5% reported no usual source of care. Over 25% reported not going to a doctor or other health care provider when they thought they should (foregone care). There were significant gender differences in reasons given for foregone care. Feeling connected to others was a significant predictor of having had a physical examination and negatively associated with foregone care for girls. For boys, connectedness and use of alcohol were negative predictors of foregone care.

Conclusions: The majority of Hispanic youth in this sample report having a usual source of medical care and the source differs by place of birth. Adolescents who do not report high levels of connectedness are more likely to have foregone care. The most frequent explanation given for not having sought care was that subjects thought the problem would go away. Socialization about how to access and use health care services, as well as what to expect, is needed by Hispanic adolescents who may be at risk.     

Child abuse and mental health among adolescents in dependent care.

Do adolescents in dependent care who have been abused or neglected demonstrate more mental health problems than their nonabused peers? This study examined relationships of child abuse, depression, and self-esteem among 82 adolescents (mean age 14.5 years, 52% male, 82.9% white) living in a dependent care facility. Of these, 32 adolescents were victims of child abuse or neglect. Upon admission, 54 adolescents were identified as depressed on the Beck Depression Inventory. Initial scores on the depression and self-esteem instruments did not differ by age, race, or history of maltreatment, though trends among subtypes of abuse were identified. Females had significantly lower self-esteem and tended toward more depression. Repeat evaluation 6 months after admission revealed significant improvement in both depression and self-esteem scores for the entire sample. As a group, however, the maltreated adolescents did not demonstrate significant improvement in depression, and a history of neglect was associated with less improvement. Depression in this dependent care sample was common, however, we did not identify the maltreated adolescents as having significantly more problems with self-esteem or depression. For some adolescents, dependent care may be an appropriate and helpful alternative.     

Abstracts of state legislated hospital cost-containment programs.

This report summarizes State legislated efforts to control rising hospital costs and the status of these efforts in May 1982. The abstract for each of 17 State programs summarizes key legislative features and operating aspects. The States included in this report are: Arizona, California, Connecticut, Florida, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Rhode Island, Virginia, Washington, West Virginia, and Wisconsin, The abstracts focus on programs requiring the disclosure, review, or legislation of hospital rates and budgets.     

Behavioral health home impact on transitional care and readmissions among adults with serious mental illness

ObjectiveTo evaluate the impact of Maryland''s behavioral health homes (BHHs) on receipt of follow‐up care and readmissions following hospitalization among Medicaid enrollees with serious mental illness (SMI).Data SourcesMaryland Medicaid administrative claims for 12 232 individuals.Study DesignWeighted marginal structural models were estimated to account for time‐varying exposure to BHH enrollment and time‐varying confounders. These models compared changes over time in outcomes among BHH and comparison participants. Outcome measures included readmissions and follow‐up care within 7 and 30 days following hospitalization.Data Collection/Extraction MethodsEligibility criteria included continuous enrollment in Medicaid for the first two years of the study period; 21‐64 years; and use of psychiatric rehabilitation services.Principal FindingsOver three years, BHH enrollment was associated with 3.8 percentage point (95% CI: 1.5, 6.1) increased probability of having a mental health follow‐up service within 7 days of discharge from a mental illness–related hospitalization and 1.9 percentage point (95% CI: 0.0, 3.9) increased probability of having a general medical follow‐up within 7 days of discharge from a somatic hospitalization. BHHs had no effect on probability of readmission.ConclusionsBHHs may improve follow‐up care for Medicaid enrollees with SMI, but effects do not translate into reduced risk of readmission.     

北京市儿童青少年静坐行为现状

了解北京市儿童青少年静坐行为现状及对健康状况的影响,为健康行为干预制定提供科学依据.方法 使用中文修订版“学龄儿童健康行为”问卷对北京市6个区县5 876名11,13,15岁儿童青少年的静坐行为和健康状况进行调查.结果 儿童青少年上学日和周末静坐行为总时间分别为3.75和8.03 h,随年龄增长呈上升趋势.做作业是上学日静坐行为的主要来源,占64.9%;看电视、用计算机和玩游戏所占比例仅为21.0%,8.5%和5.3%.周末做作业时间所占比例下降至39.0%,视屏时间比例增加.11,13,15岁儿童青少年上学日视屏时间>2h的比例分别为37.9%,29.3%和19.8%,而周末视屏时间>2 h的比例分别为79.9%,85.1%,87.0%.结论 北京市儿童青少年静坐行为状况不容乐观,尤其做作业时间过长.教育与卫生部门应该针对青少年静坐行为特点开展健康行为教育工作.     

书包使用对青少年肌肉骨骼健康的影响

多数国家青少年学生书包重量远超其国家健康指南推荐的适宜书包重量.书包超重严重影响了青少年肌肉骨骼系统的正常发育,不仅导致出现圆肩、驼背、头前倾等异常姿势,更是颈椎病、腰背痛、脊柱侧弯等青少年肌肉骨骼系统疾病的主要诱因之一.然而,青少年及其家长并未充分认识到超重书包带来的危害,更不了解书包选择与使用方面的健康知识.为引起...     

Prevalence and patterns of discrimination among U.S. health care consumers.

The authors examine the prevalence and patterns of perceived discrimination in the U.S. health care system and examine social status variables as determinants, using data from the Commonwealth Fund's Minority Health Survey. The primary social status groups of interest are age, race, ethnicity, social class, sex, and health status. Each social status category placed respondents at greater risk of perceiving discrimination based on the corresponding source of discrimination. That is, younger respondents were more likely to perceive age discrimination than were older respondents. African Americans and Hispanics perceived more race discrimination than whites. Low-income individuals experienced class discrimination, women experienced sex discrimination, and individuals who reported being in poor health were more likely to perceive discrimination based on health or disability status.     

The effects of cost-containment on home health agencies.

Home health agencies are examined in terms of changes their organizations have experienced as a result of federal health care cost-containment policies. Contrasts are made between data collected from a sample of home health agencies in 1983 and 1984. Some attention is also given to differences in home health agency experiences by state. Home health agencies are beginning to change their tax status to for-profit and to try to attract private insurance clients which may potentially alter the home health market in favor of younger clients. The agencies experienced many more denial of claims by the Medicare fiscal intermediaries in 1984 than in 1983.     

The dissemination of cost-effective psychosocial programs for children in health care settings.

Psychosocial programs for children must be both efficient and efficacious. Efficiency is dictated by cost, case of implementation, and likelihood of program compliance. Unfortunately, in attempting to promote efficient programs, inefficacious programs have been disseminated. Also, there are instances of failing to disseminate efficacious programs because they are not efficient. This paper presents a three-stage model as a guide for the dissemination of psychosocial programs. Further, specific suggestions are given as to how we may move from the level of efficacious treatments that are currently used on a limited scale to widespread dissemination.     

屏幕时间与儿童青少年健康的研究进展

随着儿童青少年屏幕时间的不断增加,关于屏幕时间的研究也不断增加,本文主要综述屏幕时间对儿童青少年不良行为习惯、生理健康、心理健康的影响,以便为后期探讨屏幕时间影响儿童青少年健康的研究提供参考。     

屏幕时间与儿童青少年健康的研究进展

随着儿童青少年屏幕时间的不断增加,关于屏幕时间的研究也不断增加,本文主要综述屏幕时间对儿童青少年不良行为习惯、生理健康、心理健康的影响,以便为后期探讨屏幕时间影响儿童青少年健康的研究提供参考。     

Effects of Medicaid managed care programs on health services access and use

OBJECTIVE: To estimate the effects of Medicaid managed care (MMC) programs on Medicaid enrollees' access to and use of health care services at the national level. DATA SOURCES/STUDY SETTING: 1991-1995 National Health Interview Surveys (NHIS) and a 1998 Urban Institute survey on state Medicaid managed care programs. STUDY DESIGN: Using multivariate regression models, we estimated the effect of living in a county with an MMC program on several access and use measures for nonelderly women who receive Medicaid through AFDC and child Medicaid recipients. We focus on mandatory programs and estimate separate effects for primary care case management (PCCM) programs, health maintenance organization (HMO) programs, and mixed PCCM/HMO programs, relative to fee-for-service (FFS) Medicaid. We control for individual and county characteristics, and state and year effects. DATA COLLECTION/EXTRACTION METHOD: This study uses pooled individual-level data from up to five years of the NHIS (1991-1995), linked to information on Medicaid managed care characteristics at the county level from the 1998 MMC survey. PRINCIPAL FINDINGS: We find virtually no effects of mandatory PCCM programs. For women, mandatory HMO programs reduce some types of non-emergency room (ER) use, and increase reported unmet need for medical care. The PCCM/HMO programs increase access, but had no effects on use. For children, mandatory HMO programs reduce ER visits, and increase the use of specialists. The PCCM/HMO programs reduce ER visits, while increasing other types of use and access. CONCLUSIONS: Mandatory PCCM/HMO programs improved access and utilization relative to traditional FFS Medicaid, primarily for children. Mandatory HMO programs caused some access problems for women.     

Current features of mental health care of children and adolescents in the primary health care system

The paper considers the state-of-the-art in mental health care in children and adolescents. It reflects the current features of this medical field. Some official statistical data of the Ministry of Health of the Russian Federation on morbidity and incidence of major mental diseases in this contingent of patients are analyzed. The most evident recent dynamic trends and the specific features of organization of specialized mental care at the present stage are examined.     

儿童青少年视屏时间及其对心理健康影响研究进展

目前电子产品使用的普遍化和低龄化已成为全球趋势, 多数儿童青少年每天视屏时间超过指南推荐(< 2 h)。研究综述了视屏时间对儿童青少年身心健康的影响及其与儿童青少年心理障碍的关系, 发现视屏时间过长对儿童青少年的身心健康存在负面影响, 且视屏时间与抑郁焦虑、情绪异常、社会适应障碍、行为障碍、自伤行为、危险行为存在正相关。目前相关研究主要集中在视屏时间过长与儿童青少年心理健康的相关性上, 缺少对其作用机制、影响因素的研究, 有待开展相关研究, 并探索有效的干预措施, 为提高儿童青少年健康水平提供依据。     

抑郁症状和情绪性进食行为对青少年膳食模式的影响

分析抑郁症状和情绪性进食行为对青少年膳食模式的影响,为指导青少年采取科学合理的膳食模式提供参考.方法 整群抽取江苏省徐州市10所中学5 473名初一和高一的在校学生为研究对象,采用儿童抑郁症状自评量表、荷兰进食行为问卷和膳食频率量表等对青少年进行问卷调查.结果 青少年膳食模式共归纳成3种,分别为“传统食物型”“零食型”和“高能量型”.在控制性别、年龄、年级、体质量指数、独生子女、父亲文化程度、母亲文化程度和自评家庭经济条件变量后,有抑郁症状的青少年情绪性进食行为发生风险比无抑郁症状的青少年增大2.20倍(95% CI=1.88~2.58);有抑郁症状的青少年“传统食物型”食物摄入降低(OR=0.593),“零食型”和“高能量型”食物摄入增加(OR值分别为1.306,1.697);有情绪性进食行为的青少年“传统食物型”食物摄入降低(OR=0.796),“零食型”和“高能量型”食物摄入均增加(OR值分别为1.687,1.463).结论 抑郁症状和情绪性进食行为与青少年膳食模式密切相关.应重视青少年情绪症状,通过改善青少年不良的情绪症状,选择正确的膳食模式.     

Differences in the use of health care facilities and patterns of general risk factors in farmers with and without occupational health care programs.

To investigate whether differences in the use of health care facilities and the distribution of risk factors were related to the accessibility of occupational health services, 912 farmers in a large research project were studied. Information was collected from nine different localities in rural areas, using questionnaires, standardized interviews, physical examinations, and blood tests. The results showed that there was hardly any difference in the use of general health care facilities between the groups. Those with occupational health services generally had more medical visits, but also had fewer diagnoses of cardiac disease. Known risk factors were present more often in the group without occupational health services. The work of the occupational health care service and the individual's interest in health questions appeared to be of significance in the way the risk factors were distributed.