To anticipate the clinical challenges and financial risks facing physicians and managed care organizations who care for children with chronic illnesses, such as sickle cell anemia (SCA), under capitated managed care arrangements.
A cross-sectional study based on claims data from the Washington State Medicaid Program (WSMP) and the Federal Employees Health Benefits Program (FEP).
Expenditure patterns were compared for children 18 years of age or younger for whom a claim with a diagnosis of SCA was submitted and paid in the State of Washington during fiscal year 1993 (FY1993) or by the FEP during FY1992 to expenditure patterns for all children.
Children with SCA had mean expenditures 8.8 times the mean expenditures for all children in WSMP.
There was wide variation in the annual expenditures among children with SCA ; the most expensive 10% of children accounted for 56% of total expenditures.
Ninety-seven percent of the expenditures were concentrated in four broad categories : 72% for inpatient care, 11% for outpatient care, 11% for physician payments, and 3% for prescription drugs.
Examination of expenditure and utilization patterns for children with sickle cell anemia enrolled in the FEP yielded similar results.
Unless managed care organizations and capitated pediatricians receive payment rates that reflect the higher expected expenditures of caring for these children, access to and quality of care may suffer. (...)
Mots-clés Pascal : Anémie hématie falciforme, Enfant, Homme, Chronicité, Coût, Etude transversale, Etats Unis, Amérique du Nord, Amérique, Financement, Politique sanitaire, Assurance maladie, Hémopathie, Anémie hémolytique, Hémoglobinopathie, Maladie héréditaire
Mots-clés Pascal anglais : Sickle cell anemia, Child, Human, Chronicity, Costs, Cross sectional study, United States, North America, America, Financing, Health policy, Health insurance, Hemopathy, Hemolytic anemia, Hemoglobinopathy, Genetic disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0056662
Code Inist : 002B19A01. Création : 31/05/1999.