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Health Care Costs and Financing

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Hospital data can be used to track the impact of the State Children's Health Insurance Program

Appropriate treatment of certain conditions, such as asthma, in primary care settings can prevent or reduce hospitalizations for the condition. Hospitalizations for these so-called ambulatory-care-sensitive (ACS) conditions can indicate the inadequacy of primary care, and a number of States plan to use ACS admission rates as a measure in tracking the impact of their State Children's Health Insurance Program (SCHIP).

A recent study shows that hospitalizations for ACS conditions increased for uninsured and Medicaid-insured children between 1990 and 1995. During the same period, the hospital admission rates for privately insured children with the same conditions fell by more than one-third. The 19 States included in the study varied in their rates of hospital admissions for asthma for all children regardless of payer, from a low of 1.37 per 1,000 children in Iowa to 4.75 per 1,000 in New York where there was a higher proportion of self-pay and Medicaid-enrolled cases.

These data, which are from the period prior to State initiatives to expand health insurance coverage for low-income children through the SCHIP, can be used by States as benchmark data. SCHIP was established by Congress in 1997 for States to develop programs to expand health insurance coverage to uninsured children via different benefits packages, eligibility levels, cost-sharing, outreach, or other activities.

To the degree that focusing on ACS conditions as one aspect of improving quality of primary care for the uninsured leads to improvement in local practice patterns, it could benefit insured populations as well, suggest Agency for Healthcare Research and Quality researchers Bernard Friedman, Ph.D., Claudia Steiner, M.D., M.P.H., and Arlene Bierman, M.D., M.S. The researchers, along with colleague Joanne Jee, M.P.H., of the Office of the Secretary, Department of Health and Human Services, based their findings on National and State hospital data for 19 States from AHRQ's Healthcare Cost and Utilization Project (HCUP) inpatient sample of hospital discharge records for ACS conditions.

More details are in "Tracking the State Children's Health Insurance Program with hospital data: National baselines, State variations, and some cautions," by Dr. Friedman, Ms. Jee, and Drs. Steiner and Bierman, in the December 1999 Medical Care Research and Review 56(4), pp. 440-455. Reprints (AHRQ Publication No. 00-R009) are available from the AHRQ Publications Clearinghouse.

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