Diverting managed care Medicaid patients from pediatric emergency department use.
To evaluate the health outcomes of managed care Medicaid children with non-emergent conditions who were not authorized to be seen in the Pediatric Emergency Department (PED) by their primary care provider.
Consecutive case surveillance from 6/29/92 to 2/2/93.
University based PED (17,500 visits/year) in inner city Baltimore.
Cases were MAC children denied authorization to be seen for non-emergent conditions in the PED.
Age and complaint matched MAC children were selected from the university based Pediatric Ambulatory Center (PAC) and from non-emergent PED visits (PED-seen) in order to compare utilization rates after denial.
The Maryland Access to Care (MAC) Medicaid program (started in 12/91) emphasizes primary care and appropriate health care utilization by incorporating the following elements of managed care : assignment to primary care provider, gatekeeping, mandatory enrollment and fee for service.
Consecutive case surveillance from 6/29/92 to 2/2/93 was used to evaluate the health outcomes of MAC children denied authorization for non-emergent care in a university based PED.
One week following denial, a pediatric nurse practitioner contacted the patient's caretaker and the MAC provider to ascertain health outcome.
Mots-clés Pascal : Etats Unis, Evaluation, Utilisation, SAMU, Assurance maladie, Enfant, Amérique du Nord, Amérique, Homme, Service hospitalier, Système santé
Mots-clés Pascal anglais : United States, Evaluation, Use, Emergency medical care unit, Health insurance, Child, North America, America, Human, Hospital ward, Health system
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0148872
Code Inist : 002B30A11. Création : 09/06/1995.