Bronstein Janet M, Adams E Kathleen, Florence Curtis S
University of Alabama, School of Public Health, Birmingham 35294-0022, USA.
Health Care Financ Rev. 2006 Summer;27(4):41-51.
This study explores the impact of program structure on children's use of care by comparing care use in State Children's Health Insurance Program (SCHIP) and Medicaid covered populations in a State where children share the same provider network and are both in a primary care case management system with the same Medicaid fee structure. We then compare care use in this system to care use in an SCHIP structured as a fee-for-service (FFS) system using a private insurance provider network and fee schedule. Where SCHIP and Medicaid Programs share a primary care case management (PCCM) system, we find more use of well-child care among Medicaid covered children, but more use of office-based physician care among SCHIP covered children. Across the Medicaid PCCM-based and the private insurance FFS-based system, we find more use of primary and specialty care in the FFS system, and more use of well-child care and less use of emergency departments for non-urgent care in the PCCM-based system.
本研究通过比较儿童共享相同提供者网络且都处于具有相同医疗补助费用结构的初级保健病例管理系统中的一个州的儿童健康保险计划（SCHIP）和医疗补助覆盖人群的医疗服务使用情况，探讨了计划结构对儿童医疗服务使用的影响。然后，我们将该系统中的医疗服务使用情况与使用私人保险提供者网络和费用表的按服务收费（FFS）系统结构的SCHIP中的医疗服务使用情况进行比较。在SCHIP和医疗补助计划共享初级保健病例管理（PCCM）系统的情况下，我们发现医疗补助覆盖的儿童更多地使用儿童健康保健服务，但SCHIP覆盖的儿童更多地使用门诊医生服务。在基于医疗补助PCCM的系统和基于私人保险FFS的系统中，我们发现FFS系统中更多地使用初级和专科护理，而基于PCCM的系统中更多地使用儿童健康保健服务，并且在非紧急护理中较少使用急诊科。
