Urban Institute, Washington, DC 20037, USA.
Health Serv Res. 2011 Feb;46(1 Pt 2):298-318. doi: 10.1111/j.1475-6773.2010.01199.x. Epub 2010 Nov 5.
To examine changes in children's receipt of well-child and preventive dental care in Medicaid/Children's Health Insurance Program (CHIP) in two states that adopted policies aimed at promoting greater preventive care receipt.
The 2004-2008 Medicaid/CHIP claims and enrollment data from Idaho and Kentucky.
Logistic and hazard pre-post regression models, controlling for age, gender, race/ethnicity, and eligibility category.
Claims and enrollment data were de-identified and merged.
Increased reimbursement had a small, positive association with well-child care in Idaho, but no consistent effects were found in Kentucky. A premium forgiveness program in Idaho was associated with a substantial increase (between 20 and 113 percent) in receipt of any well-child care and quicker receipt of well-child care following enrollment. In Kentucky, children saw modest increases in receipt of preventive dental care and received such care more quickly following increased dental reimbursement, while the move to managed care in Idaho was associated with a small increase in receipt of preventive dental care.
Policy changes such as reimbursement increases, incentives, and delivery system changes can lead to increases in preventive care use among children in Medicaid and CHIP, but reported preventive care receipt still falls short of recommended levels.
研究在两个实施了旨在促进更多预防保健服务的政策的州，医疗补助/儿童健康保险计划（CHIP）中儿童接受常规儿童保健和预防牙科保健服务的变化情况。
来自爱达荷州和肯塔基州的 2004-2008 年医疗补助/CHIP 索赔和登记数据。
使用对数和风险前后回归模型，控制年龄、性别、种族/民族和资格类别。
对索赔和登记数据进行去识别和合并。
在爱达荷州，报销增加与常规儿童保健服务有较小的正相关关系，但在肯塔基州未发现一致的影响。爱达荷州的保费豁免计划与任何常规儿童保健服务的获得率大幅增加（增加 20%至 113%）以及登记后获得常规儿童保健服务的速度加快有关。在肯塔基州，儿童接受预防性牙科保健服务的比例略有增加，并且在增加牙科报销后更快地接受此类服务，而爱达荷州向管理式医疗的转变与预防性牙科保健服务获得率的小幅增加有关。
报销增加、激励措施和交付系统变化等政策变化可以促使医疗补助和 CHIP 中的儿童增加预防保健服务的使用，但报告的预防保健服务使用率仍低于推荐水平。
