DeGraw View Graph # 1

Ambulatory Health Care Use by Children

Prevalence/Service Use of Children With Chronic Illness

Special Health Care Needs Among Low-Income, Uninsured Children

Implications for Benefit Package Design Under CHIP

OVERVIEW

DeGraw View Graph # 2

AMBULATORY HEALTH CARE VISITS

NCHS, 1998

All ages 2.89

Under 1 year 8.15

1-4 years 3.63

5-14 years 2.04

DeGraw View Graph # 3

AMBULATORY VISITS AMONG CHILDREN UNDER AGE 1, BY PRINCIPAL DIAGNOSIS

NCHS, 1998

Total number of visits 8.15

Well-child visit 2.56

Middle ear infection 1.1

Runny nose, cough .8

DeGraw View Graph # 4

Children affected by a chronic condition……………….31%

Highly prevalent conditions include:

Respiratory allergiesRepeated ear infectionsAsthma

CHRONIC CHILDHOOD ILLNESS: PREVALENCE, SEVERITY, IMPACT

NHIS data, Newacheck and Taylor, 1992

DeGraw View Graph # 5

Mild……………………………66%

Moderate……………...……….29%

Severe…………………..……….5%

PERCENTAGE DISTRIBUTION OF CHILDREN WITH CHRONIC CONDITIONS, BY SEVERITY LEVEL

NHIS data, Newacheck and Taylor, 1992

DeGraw View Graph # 6

DISABILITY AMONG UNINSURED CHILDREN IN LOW INCOME FAMILIES

1994 NHIS data, Maternal & Child Health Policy Research Center

Mild1.7%

Moderate3.7%

Severe0.9%

No Disability93.7%

DeGraw View Graph # 7

CHRONIC CONDITIONS, SPECIAL NEEDS, AND DISABILITY FOR CHILDREN UNDER 18 YEARS OLD

DeGraw View Graph # 8

SPECIAL HEALTH CARE NEEDS AMONG UNINSURED CHILDREN IN LOW INCOME FAMILIES

With Special Health

Care Needs16.9%

Without Special Health

Care Needs83.1%

Source: Newacheck et al. March 1998

DeGraw View Graph # 9

PREVALENCE OF CHILDREN WITH A DISABILITY, BY AGE

< 3 years 2.2 %

3-5 years 5.2 %

6-14 years 6.3 %

15-17 years 9.3 %

SIPP data, CDC, 1995

DeGraw View Graph # 10

The 5 % With Severe Conditions Accounted For:

19% of Physician Contacts

33% of Hospital Days

SERVICE UTILIZATION BY CHILDREN WITH CHRONIC CONDITIONS

NHIS data, Newacheck and Taylor, 1992

DeGraw View Graph # 11

COVERING A CONTINUUM OF CARE FOR CHILDREN

Preventive Primary Acute Specialty Ancillary/Support

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Medical Necessity

Provider Network Requirements

Relationships Between MCOs and Other Agencies/Programs

Contracting With MCOs

THINK BEYOND THE BENEFITS PACKAGE

DeGraw View Graph # 13

Children Need a Range of Services

You Don’t Need to Reinvent the Wheel

Make Sure the Benefits Children Need Are Available--Be Creative!

SUMMARY POINTS

DeGraw View Graph # 14

Benefits - Additional Categories clinic services, over-the counter medications, prenatal care and family

planning services and supplies, inpatient mental health services, durable medical equipment and

other medically relatedremedial devices and supplies,

home and community-basedhealth care, nursing careservices, hospice care andrelated services,

outpatient, inpatient, andresidential substance abusetreatment and services,

dental services

case management and carecoordination services physical, occupational, and speech,hearing, and language therapy,medical transportation,enabling services (e.g. outreach,transportation, translation) to increaseaccess to primary/preventive care,any other medical, diagnostic,screening, preventive, restorative,remedial, therapeutic, orrehabilitative services recognized bystate law and prescribed or furnishedby a licensed practitioner, andany other health care services ortimes specified by the Secretary.

BENEFITS ADDITIONAL-CATEGORIES