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Biomedical subjects

N Halfon

Publications and source records attributed to N Halfon.

At least 73 records · Page 4Linked to original sources
PubMed1992

Children in foster care in California: an examination of Medicaid reimbursed health services utilization.

The number of children in foster care in California doubled from 27,534 in 1980 to more than 62,419 in 1988, representing approximately 1% of the child population in the state. Past studies have demonstrated that children in foster care have high rates of medical and mental health problems. An examination of all Medi-Cal-paid claims was undertaken to describe the utilization of health services by children in foster care. Although children in foster care represent 4% of Medi-Cal-eligible children younger than 18 years of age, they account for approximately 5% of children using Medi-Cal services and 6.7% of expenditures, representing a 23% greater utilization rate and 41% greater expenditure rate than all children covered by Medi-Cal. Using the entire Medi-Cal population younger than 18 years of age as comparison group, examination of inpatient and outpatient service utilization for specific condition categories showed few differences between children in foster care and the comparison group except for mental health service utilization, where children in foster care were much higher users of services.

Adolescent↗
PubMed1992

Mental health service utilization by children in foster care in California.

An examination of Medi-Cal-paid claims was undertaken to assess the utilization of mental health services by children in California's foster care system. Using unduplicate counts of service use and diagnoses, it was determined that children in foster care account for 41% of all users of mental health services even though they represent less than 4% of Medi-Cal-eligible children. When partitioned into specific service categories, children in foster care account for 53% of all psychologist visits, 47% of psychiatry visits, 43% of Short Doyle/Medi-Cal inpatient hospitalization in public hospitals, and 27% of inpatient psychiatric hospitals. Expenditure for services paralleled utilization frequency. When compared to the non-foster care Medi-Cal-eligible child population, children in foster care have 10 to 20 times the rate of utilization per eligible child for selected services. For children in foster care, 75% of all diagnoses for billed service were accounted for by four diagnoses: adjustment disorders (28.6%), conduct disorders (20.5%), anxiety disorders (13.8%), and emotional disorders (11.9%), with clear age-related differences in the distribution of diagnoses.

Adolescent↗
PubMed1990

Immunizing California's children. Effects of current policies on immunization levels.

Data collected by the Immunization Unit of the California Department of Health Services from 1979 to 1987 were analyzed to determine the effects of changes in state policy on the immunization levels of children in California. By December 1986, 90% of all children entering kindergarten in California were adequately immunized, representing a 15% increase from 1979. Although California has shown substantial improvements, it still lags behind the national weighted average. Even with high levels of immunization at kindergarten entry, many toddlers of 7 months and 2 years old remain inadequately immunized. Children immunized solely in the private sector were more adequately immunized than those served by public health clinics; the public-private difference for infants aged 7 months was nearly twofold.

California↗
PubMed1988

Preventive care use by school-aged children: differences by socioeconomic status.

Use of ambulatory care services by children from low-income families has increased substantially since the early 1960s. However, in few studies have attempts been made to disaggregate physician visits according to type (eg, preventive upsilon diagnosis and treatment). In this study, receipt of preventive care (including physical, vision, and dental examinations), based on a sample of 16,838 children aged 5 to 16 years from the 1982 National Health Interview Survey, was examined. The results indicate that children in families with incomes below the poverty level, especially those without Medicaid insurance, are much less likely to receive routine preventive care on a timely basis. Poor school-aged children with Medicaid are much more likely to receive timely preventive care than their counterparts without Medicaid coverage. The effectiveness of preventive care for children is discussed and suggestions for improving access to routine preventive care are presented.

Adolescent↗
PubMed1987

Mental health care for foster children in California.

This paper reports on a study conducted to assess the health care needs of foster children in California. To evaluate foster children's mental health problems and the services provided to meet them, 154 program administrators, social workers, foster parents, and health care providers were interviewed in 14 counties. Foster parents and social workers were interviewed in groups, and foster parents and administrators also completed questionnaires. We found that although all counties care immediately for children who are injured, abused, or ill, only one county performs routine mental health evaluations of all children, and in most counties less than a third of children ever receive such evaluations. Informants identified mental health problems as more severe than medical problems in this population, and they identified four major barriers to access to appropriate therapy. Recommendations are that all children should receive comprehensive mental health evaluations, and procedures for immediate and ongoing care with consistent providers who are sensitive to foster children's needs should be included in case management plans, and covered by improved payment mechanisms. Additionally, communication, coordination and joint planning should be instituted among relevant agencies to address foster children's needs, and increased resources and training should be directed towards social service agencies and foster parents.

California↗
PubMed1987

Health services for California's foster children: current practices and policy recommendations.

The organization and delivery of health services to children in foster care was investigated in 14 California counties in 1985. Foster care administrators, child welfare workers, foster parents, and health care providers responded to questionnaires and structured interviews performed by two pediatricians knowledgeable about the child welfare system. The organization of health services demonstrated a high degree of variability between counties. Although some counties initially evaluate all dependent children using specific protocols and examinations sites, more often services were poorly organized, fragmented, and had few safeguards to ensure delivery of appropriate health care. Use of recommended Early Periodic Screening Diagnosis and Treatment services was also variable, and counties could not provide documentation of use rates by foster children. Even less consistent was the performance of routine initial mental health assessments. Financial disincentives, fewer available providers, difficulties in obtaining and using Medicaid-reimbursed services, and fragmentation of services were frequently identified as barriers to access. To improve the organization and delivery of services, access barriers must be diminished, services must be better organized and integrated, and new financing mechanisms must be developed. Specific policy recommendations are presented.

California↗
PubMed1986

Prevalence of activity limiting chronic conditions among children based on household interviews.

According to data from the National Health Interview Survey (NHIS) over two million children under 17 years (3.8%) are afflicted by chronic conditions that cause some limitation of activity. The limitations range from complete inability to attend school for school age children or inability to engage in play for preschoolers to limited ability to engage in athletics or other social activities. Analysis of micro data from the NHIS reveals that the leading causes of activity limitation include: respiratory diseases; speech, special sense and intelligence related impairments; and mental and nervous system disorders. Together these conditions account for 50% of all childhood activity limitations. Despite their small numbers, children with activity limitations are reported by the NHIS to consume a disproportionate share of health care resources, including over twice as many physician services and over seven times as many hospital services as other children. Household interviews appear to be a useful vehicle for assessing prevalence of activity limitations but researchers and others should be cautioned about the subjective nature of the activity limitation concept.

Activities of Daily Living↗
PubMed1986

The association between mother's and children's use of physician services.

Using data from the National Health Interview Survey on approximately 30,000 children, maternal and child ambulatory care utilization patterns are compared. The results indicate that maternal physician utilization is closely associated with child utilization, as measured by presence or absence of a physician visit over the course of a year as well as annual volume of use. Maternal use appears to be a more powerful predictor of child use than several other family and maternal variables. These results confirm and expand on those of previous localized population-based studies and suggest that interventions directed at the mother may be effective in ensuring equitable and efficient use of ambulatory services by children.

Adolescent↗
PubMed1986

The financial burden of medical care expenses for children.

Data from the 1980 National Medical Care Utilization and Expenditure Survey are used to assess whether financial burdens incurred in obtaining medical services for children are distributed equitably among families with different incomes. When measured in absolute terms, out-of-pocket charges appear to increase in a progressive fashion with family income. However, when out-of-pocket charges are measured relative to ability to pay, a regressive pattern is demonstrated. Within the poverty population, children with continuous Medicaid coverage have much lower out-of-pocket costs than other children. Extension of Medicaid coverage to additional children below poverty is suggested as one approach toward reducing current inequities.

Child↗
PubMed1986

Trends in the hospitalization for acute childhood asthma, 1970-84.

Data from the 1970 through 1984 National Hospital Discharge Surveys indicate that the rate of hospitalization for children under 15 years old with asthma has increased at least 145 per cent while the average length of stay for children with asthma decreased by 26 per cent from 5 days in 1970 to 3.6 days in 1984. Over an analogous period (1970 to 1980), data from the National Health Interview Survey indicate that the prevalence of childhood asthma has increased by approximately 28 per cent for children 6 to 16 years of age. Several potential explanations for the hospital trend are discussed, including changes in the disease classification and information system, criteria for admission, organizational factors, changes in therapy, and changes in morbidity.

Adolescent↗
PubMed1986

Trends in activity-limiting chronic conditions among children.

Data from the National Health Interview Survey indicate that the prevalence of activity-limiting chronic conditions among children under age 17 years doubled between 1960 and 1981, from 1.8 to 3.8 per cent. Approximately 40 per cent of the overall rise in prevalence occurred before 1970. Most of the increase in prevalence during this early period can be attributed to changes in questionnaire design and aging of the child population following the "baby boom" years. The factors responsible for increases in reported cases of activity limitation following 1970 are more difficult to specify and evaluate. During this later period, the increase in prevalence was restricted to less severe levels of limitations. While prevalence levels rose for a variety of conditions during this period, respiratory conditions and mental and nervous system disorders demonstrated the largest changes. It appears that much of the increase in reported cases of activity limitations during the 1970s can be attributed to shifting perceptions on the part of parents, educators, and physicians.

Activities of Daily Living↗
PubMed1986

Access to ambulatory care services for economically disadvantaged children.

Using data from the 1981 Child Health Supplement to the National Health Interview Survey, we examined differences in access to ambulatory services for children of different family incomes. The results indicate that much progress has been made in equalizing access since the War on Poverty was initiated in the mid-1960s. Poor children with superior health status now generally see physicians at the same rates as children in similar health but from higher income families. However, children with substantial health problems from low-income families continue to lag behind their higher income counterparts in similar health. Medicaid was shown to substantially improve access to ambulatory services for economically disadvantaged children in poor health, but less than half of these children are covered by Medicaid. Recent changes in federal and state policies concerning Medicaid are discussed as well as policy options for addressing the needs of children afflicted by both poverty and ill health.

Ambulatory Care↗
PubMed1986

Capitation in California--an analysis of at-risk financing of Medicaid services.

Recent legislative changes have fostered the growth of a highly competitive health care market in California. In addition to selective hospital contracting for Medicaid (Medi-Cal) services, the California Medical Assistance Commission is attempting to initiate pilot projects to capitate Medi-Cal beneficiaries in selected geographic areas throughout the state. Selective contracting with county capitated organized health systems is also underway in Santa Barbara County, with plans for other counties on the drawing boards. This paper describes these capitated programs as well as addressing problems that may arise in this transition from a fee-for-service to a capitated Medi-Cal system. Specifically considered are issues related to underutilization, quality of care, implementation, eligibility and effects on existing patterns of care.

California↗
PubMed1985

Factors influencing the utilization of health care by children.

Although access for children was improved in the decade following the institution of Medicaid, utilization of health services by children remains unequal. Families with more resources at their disposal are more likely to obtain higher quality and more appropriate care for their children. At the same time poor children appear to be at greater risk for most childhood ailments, and use less services than they need. In addition to need for care, utilization appears to be influenced by income, insurance and several maternal factors including marital and employment status. A number of other factors are discussed, including trends in chronic illness, new morbidities, and the increased incidence of children living in impoverished single-parent households.

Acute Disease↗
PubMed1981

Fatal echovirus type 11 infections.

Two infants with fatal echovirus type 11 infections are described. Disseminated intravascular coagulation developed in both patients, and at postmortem examination, diffuse hemorrhagic necrosis of multiple organ systems was evident, most strikingly in the liver. A 3-month-old child is described, in whom lethargy, vomiting, pitting edema of the occipital scalp and neck, and subsequent diffuse echovirus disease developed. The clinical manifestation in this infant of focal myositis with histologic documentation at postmortem examination is unique to echovirus 11 disease. To our knowledge, this child represents the first described patient with nonparalytic, fatal echovirus type 11 infection occurring beyond the immediate neonatal period.

Disseminated Intravascular Coagulation↗
PubMed1978

Development of the interpeduncular nucleus in the midbrain of Rhesus monkey and human.

The development of the interpeduncular nucleus (IPN) in primates was studied in rhesus monkey with 3H-thymidine autoradiographic, Nissl and Golgi methods and in humans in histological preparations from embryos and fetuses of different ages. Autoradiographic analysis demonstrated that the neurons of the monkey IPN underwent their final cell division between postconception day 36 (E36) and E42, which corresponds to Stages 17 through 21 of Hendrickx and Sawyer. Autoradiograms of monkeys sacrificed at various short intervals following exposure to a pulse of 3H-thymidine showed that IPN neurons were generated in the proximity of the ventricular surface near the confluence of the 3rd ventricle and cerebral aqueduct, migrated ventrally along the midline and then spread laterally after reaching the ventral midbrain, where IPN was first recognized at E45 (Stage 23). The distribution of successively generated neurons in autoradiograms revealed caudal to rostal and lateral to medial spatiotemporal gradients. Differentiation of IPN neuronal size and development of Nissl substance began in rhesus monkey only after postmitotic cells had reached their destination and seemed to be pronounced mainly through E104. However, growth of the dendrites and elaboration of their side branches as seen in Golgi impregnations progressed gradually from E81 to birth (E165) and perhaps even later. Analysis of histological preparations of a series of human embryos and fetuses was used to derive similar information indirectly, since the autoradiographic method cannot be applied to man. It was found that IPN neurons in human probably underwent their final division between Carnegie Stage 17 and 21. Similarly, as in monkey, postmitotic cells in human IPN displayed an inverted fountain pattern of cellular migration. IPN could first be delineated at Stage 23. There was evidence for both caudal to rostral and lateral to medial spatiotemporal gradients in the human, as in the monkey. Thus, in monkey and human, all IPN neurons are generated within the first quarter of intrauterine life and there is remarkable similarity in the timing, tempo and pattern of IPN neuronal differentiation in both species, indicating the validity of using nonhuman primates as an experimental model for understanding the development of this structure in man.

Animals↗
PubMedDate not supplied

Challenges in securing access to care for children.

Congressional approval of Title XXI of the Social Security Act, which created the State Children's Health Insurance Program (CHIP), is a significant public effort to expand health insurance to children. Experience with the Medicaid program suggests that eligibility does not guarantee children's enrollment or their access to needed services. This paper develops an analytic framework and presents potential indicators to evaluate CHIP's performance and its impact on access, defined broadly to include access to health insurance and access to health services. It also presents options for moving beyond minimal monitoring to an evaluation strategy that would help to improve program outcomes. The policy considerations associated with such a strategy are also discussed.

Child↗