Jahn D, Smith D, Warner D C
Texas Department of Health, Austin.
Tex Med. 1994 Jun;90(6):80-91.
In Texas, children's health services are financed by a bewildering combination of private and public sources, each of which employs different eligibility rules, benefit packages, and reimbursement methods. This article describes these financing mechanisms, underscoring their complexity and the need for consolidation and reform. As private coverage for children has declined, it has become less comprehensive with increased coinsurance and deductibles. Concurrently, due to a number of federal initiatives, Medicaid coverage has increased rapidly with new benefits, also now mandated. Levels and structure of payment have influenced variable participation in the program by physicians, rural health clinics, federally qualified health centers, and children's hospitals. The Texas Department of Health and the Texas Department of Mental Health and Mental Retardation have undertaken a number of initiatives to fill in the gaps and to serve mandated categorically eligible populations. Continuity of care is difficult to achieve. Comprehensive community-based care should be promoted with the goal of expanding the role of all types of providers.
在得克萨斯州，儿童健康服务由私人和公共资金来源的复杂组合提供资金支持，每一种资金来源都采用不同的资格规则、福利套餐和报销方式。本文描述了这些融资机制，强调了它们的复杂性以及整合与改革的必要性。随着儿童私人医疗保险覆盖率下降，其变得不再那么全面，同时共保率和免赔额却有所增加。与此同时，由于多项联邦举措，医疗补助计划的覆盖范围随着新福利的推出而迅速扩大，现在这些新福利也是强制性的。支付水平和结构影响了医生、农村健康诊所、联邦合格健康中心和儿童医院对该计划的不同参与程度。得克萨斯州卫生部以及得克萨斯州精神健康与智力障碍部已采取多项举措来填补空白，并为法定符合条件的人群提供服务。实现连续护理很困难。应促进基于社区的全面护理，目标是扩大各类医疗服务提供者的作用。
