Association Between Insurance Type and Fluoride Varnish Application During Well-Child Visits in Massachusetts

ObjectiveTo compare rates of fluoride varnish (FV) applications during well-child visits for children covered by Medicaid and private medical insurance in Massachusetts.MethodsThis cross-sectional study analyzed well-child visits for children aged 1 to 5 years paid by Medicaid and private insurance during 2016.Çô18 in Massachusetts. Multivariate regression models, with all covariates interacting with insurance type, were used to calculate odds ratios and adjusted predicted probabilities of fluoride varnish during well-child visits by calendar year and age.ResultsAcross 957,551 well-child visits, 40.0% were paid by private insurers. Unadjusted rates of fluoride varnish were significantly lower among well-child visits paid by private insurers (6.6%) than visits paid by Medicaid (14.2%). In the fully interacted regression model, the odds of a visit including fluoride varnish were significantly lower for older children than for children aged 1 for visits paid by both insurance types. Adjusted rates of fluoride varnish increased significantly from 2016 to 2018 for both insurance types. Moreover, rates were higher among visits for children covered under Medicaid than privately insured children in all years, and the differences by insurance type declined over time (2016: 8.0% points, 95% confidence interval.á=.á.êÆ8.7 to .êÆ7.3, 2018: 5.3% points, 95% confidence interval.á=.á.êÆ6.6 to .êÆ3.9).ConclusionsRates of fluoride varnish applications during well-child visits were low for both Medicaid and private insurance despite growth from 2016 to 2018 in Massachusetts. Low rates are concerning because this is a recommended service with the potential to help address racial, geographic, and income-based disparities in access and oral health outcomes.     

Insurance Coverage and Well-Child Visits Improved for Youth Under the Affordable Care Act,but Latino Youth Still Lag Behind

Objective

To examine whether there have been changes in insurance coverage and health care utilization for youth before and after the national implementation of the Patient Protection and Affordable Care Act (ACA) and to assess whether racial and ethnic inequities have improved.

Adolescent and young adult cancer care: Financial hardship and continued uncertainty

Since 2005, there has been a steady increase in the number of new cancer diagnoses among adolescents and young adults (AYA) in the United States (US), likely due to improved awareness and detection within this age group, as well as the possible contribution of insurance expansion under the Patient Protection and Affordable Care Act. AYAs with cancer remain highly vulnerable financially, a situation that will only worsen with proposed rollbacks in access to and affordability of healthcare. In this review, we will discuss existing aspects of financial hardship and highlight areas of uncertainty, based on the current US political climate.     

Impact of Mental Health Parity and Addiction Equity Act on Costs and Utilization in Alabama's Children's Health Insurance Program

Objective

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 mandates equivalent insurance coverage for mental health (MH) and substance use disorders (SUD) to other medical and surgical services covered by group insurance plans, Medicaid, and Children's Health Insurance Programs (CHIP). We explored the impact of MHPAEA on enrollees in ALL Kids, the Alabama CHIP.

Re-hospitalization after diagnosis of diabetes varies by gender and socioeconomic status in urban African-American and Latino young people

Abstract: Purpose: To examine risk factors for re‐hospitalization after diagnosis of diabetes mellitus amongst urban minority children. Methods: Families of insulin‐treated African‐American and Latino patients aged < 18 yr at diagnosis (n = 216) were interviewed about sociodemographics and other characteristics, on average 5.9 yr after diagnosis. Results and conclusions: About 60% of respondents were re‐hospitalized at least once for diabetes‐related reasons (n = 128). Half of those questioned had Medicaid or no health insurance at all; 23% fit criteria for a non‐autoimmune, type 2 diabetic phenotype. Those who avoided re‐hospitalization were more likely to have been seen initially at a tertiary care facility, to have private health insurance, and to be males. They had, on average, 2 yr shorter duration of diabetes at the time of interview. Risk for re‐hospitalization was not associated with age at diagnosis, ethnicity, diabetic phenotype, or source of care during the past year. In multivariate analysis, predictors of re‐hospitalization were gender [odds ratio (OR) 1.98 for females vs. males (95% confidence interval (CI) = 1.05–3.72)], duration of diabetes [OR = 1.46 per yr (95% CI = 1.36–1.57)], initial ascertainment at a community hospital [OR = 5.44 vs. tertiary care facility (95% CI = 2.61–11.29)] and having Medicaid or no insurance [OR = 2.73 (95% CI = 1.42–5.24)], compared with those with another type of health insurance. There is a high risk of re‐hospitalization after the initial diagnosis of diabetes among insulin‐treated minority children, particularly the uninsured and those on Medicaid, in part related to duration of disease and where the initial treatment occurred.     

The impact of health insurance gaps on access to care among children with asthma in the United States.

BACKGROUND: Health insurance coverage is important to help assure children appropriate access to medical care and preventive services. Insurance gaps could be particularly problematic for children with asthma, since appropriate preventive care for these children depends on frequent, consistent contacts with health care providers. OBJECTIVE: The aim of this study was to determine the association between insurance gaps and access to care among a nationally representative sample of children with asthma. METHODS: The National Survey of Children's Health provided parent-report data for 8097 children with asthma. We identified children with continuous public or continuous private insurance and defined 3 groups with gaps in insurance coverage: those currently insured who had a lapse in coverage during the prior 12 months (gained insurance), those currently uninsured who had been insured at some time during the prior 12 months (lost insurance), and those with no health insurance at all during the prior 12 months (full-year uninsured). RESULTS: Thirteen percent of children had coverage gaps (7% gained insurance, 4% lost insurance, and 2% were full-year uninsured). Many children with gaps in coverage had unmet needs for care (7.4%, 12.8%, and 15.1% among the gained insurance, lost insurance, and full-year uninsured groups, respectively). In multivariate models, we found significant associations between insurance gaps and every indicator of poor access to care among this population. CONCLUSIONS: Many children with asthma have unmet health care needs and poor access to consistent primary care, and lack of continuous health insurance coverage may play an important role. Efforts are needed to ensure uninterrupted coverage for these children.     

The Brazilian Portuguese version of the Pediatric Trigger Toolkit is applicable to measure the occurrence of adverse drug events in Brazilian pediatric inpatients

Objective

To describe the process of translation, adaptation, and validation of the Brazilian Portuguese version of the Pediatric Trigger Toolkit: Measuring Adverse Drug Events in the Children's Hospital.

A Learning Loop Model of Collaborative Decision-Making in Chronic Illness

Shared decision-making is a core attribute of quality health care that has proved challenging to implement and assess in pediatric practice. Current models of shared decision-making are limited, including their capacity to incorporate multiple stakeholders; to integrate downstream effects of subacute or minor decisions; and to account for the context(s) in which such decisions are being made and enacted. Based on a review of literature from organizational psychology, cognitive sciences, business, and medicine, we propose an iterative decision-making model of care planning and identify targets at several levels of influence warranting measurement in future studies. Our learning loop model posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that “meta-learning” from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians. We consider the model in light of the needs of children with special health care needs, for whom understanding the ongoing iterative effects of decision making and clinician?parent?child dynamics are likely to be particularly important in influencing outcomes.