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Although health insurance is a critical tool for well-being across the life course, few studies have explored the long-term health implications of shifts in insurance coverage. This study examined whether changes in insurance types from adolescence to early midlife were associated with early midlife self-rated health. This study used data from Wave I (1994–1995; average age 15.7 years), Wave IV (2008–2009; average age 28.7 years), and Wave V (2016–2018; average age 37.6 years) of Add Health, including 6,765 respondents from 1994 to 2018. Logistic regression was used to examine the association between health insurance status from adolescence to early midlife and early midlife self-rated health. The analyses were conducted from March to August 2024. Relative to having private insurance in adolescence and early midlife, the following health insurance statuses in adolescence and early midlife were significantly associated with poorer early midlife self-rated health: public in adolescence and early midlife (AOR=3.34; 95% CI=1.89, 5.91); uninsured in adolescence to public at early midlife (AOR=3.29; 95% CI=1.85, 5.85); private in adolescence to public at early midlife (AOR=3.36; 95% CI=2.46, 4.58), and private in adolescence to uninsured at early midlife (AOR=1.68; 95% CI=1.10, 2.55). Health insurance statuses from adolescence to early midlife, specifically having or switching into public insurance, may be associated with poorer health in early midlife among individuals who were adolescents in the early 1990s. More research is needed to explore how insurance reform such as the Children's Health Insurance Program may have mitigated this association in future cohorts. [ABSTRACT FROM AUTHOR]

This study examined the associations between individual as well as neighborhood social vulnerability and sports and recreation-related traumatic brain injury (SR-TBI) hospitalizations among pediatric patients in the U.S. We obtained 2009, 2010 and 2011 hospitalization data in the U.S. from the National Inpatient Sample (NIS) database, linked it to 2010 neighborhood social vulnerability index (SVI) data from the Centers for Disease Prevention and Control (CDC), and assigned U.S. hospitals to one of four SVI quartiles. SR-TBI outcomes studied include: odds of hospitalization, length of stay (LOS), and discharge to post-acute care (DTPAC). We found associations between race/ethnicity and all SR-TBI outcomes; however, sex, primary payer, and neighborhood overall SVI were only associated with LOS. Compared to White children, Native American children had almost three times higher odds of hospitalization for SR-TBI (OR: 2.82, 95% CI: 1.30, 6.14), 27% longer LOS (β: 27.06, 95% CI: 16.56, 38.51), but 99.9% lower odds of DTPAC (OR: 0.001, 95% CI: 0.00, 0.01). Compared to children with private insurance, children with public insurance had 11% longer LOS (β: 10.83, 95% CI: 8.65, 13.05). Hospitalization in neighborhood with higher overall SVI was associated with longer LOS (p < 0.0001). These findings suggest that individual and neighborhood social vulnerability can have a significant impact on the health outcomes of children, especially in the context of SR-TBI. [ABSTRACT FROM AUTHOR]

Pneumococcal disease (PD) is a major cause of morbidity and mortality among children, particularly in the youngest age groups. This study aimed to assess the incidence of PD over time by age group in young children with commercial or Medicaid coverage in the US. Episodes of invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and acute otitis media (AOM) were identified in the MarketScan® Commercial and Medicaid claims databases using diagnosis codes among children aged ≤ 48 months with confirmed date of birth (DoB), at any time during the study period (1998–2019). DoB was assigned using diagnosis codes for birth or delivery using the child's or mother's medical claims to ensure accurate age determination. Annual incidence rates (IRs) were calculated as number of disease episodes/100,000 person-years (PY) for IPD and ACP and episodes/1,000 PY for AOM, for children aged 0–6, 7–12, 12–24, and 25–48 months. Annual IPD IRs declined from 53 to 7 episodes/100,000 PY between 1998 and 2019 in commercially-insured and 58 to 9 episodes/100,000 PY between 2001 and 2019 in Medicaid-insured children. Annual ACP IRs declined from 5,600 to 3,952 episodes/100,000 PY, and from 6,706 to 4,521 episodes/100,000 PY, respectively, over these periods. In both populations, children aged 0–6 months had the highest incidence of IPD and inpatient ACP. Annual AOM IRs declined from 1,177 to 738 episodes/1,000 PY (commercially-insured) and 633 to 624 episodes/1,000 PY (Medicaid-insured), over these periods. IRs were higher in rural vs. urban areas for all disease manifestations. Incidence rates of IPD, ACP, and AOM decreased in children with commercial insurance and Medicaid coverage from 1998 to 2019. However, burden of disease remained substantial, with higher annual IRs for IPD and ACP for Medicaid-insured vs. commercially-insured children. IPD and inpatient ACP were most common in the youngest children 0–6 months old, followed by the 7–12-month age group. [ABSTRACT FROM AUTHOR]

• Time from US infant birth hospitalization discharge to the first outpatient visit (FOV) was assessed. • FOV completion within 5 days of birth hospitalization discharge for Medicaid infants is substantially lower than that of commercially insured infants. • For infants born during the RSV season administration of RSV antibodies in the newborn nursery would ensure optimal uptake. New extended half-life antibodies for the single-dose prevention of medically attended (MA) respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) have been developed for administration to all infants before or during their first RSV season. For infants born during the season, administration as soon as feasible after birth would provide optimal protection and minimize access disparities. The objective of this study was to assess the time from birth hospitalization discharge to the first outpatient visit (FOV) among US infants in order to determine optimal site of administration for the extended half-life antibody. This retrospective, observational, time-to-event analysis uses the Merative™ MarketScan® Commercial and Multi-State Medicaid Databases. Time to FOV is reported separately for the COVID-19 and recent pre-COVID-19 eras and for commercially insured and Medicaid infants. Overall, 73.8 % of Medicaid infants had an FOV within 5 days as compared to 84.7 % of commercially insured infants. Estimates were higher during the COVID-19 era. Urban commercially insured infants had much higher FOV completion than their counterparts. Among Medicaid infants, urban Black and rural White infants were least likely to complete their FOV within 5 days of birth hospitalization discharge. FOV within 5 days after birth hospitalization discharge for Medicaid infants is substantially lower than that of commercially insured infants. Approximately 1 in 4 Medicaid infants and 1 in 8 infants with commercial insurance did not have an outpatient visit within 5 days of birth hospitalization discharge. For US infants born during the RSV season, administration of extended half-life RSV antibodies in the newborn nursery prior to discharge would ensure optimal uptake and minimize access disparities. [ABSTRACT FROM AUTHOR]

• RSV incidence and costs in hospitalised infants < 3 months decreased during 2020/21. • An increase in the age of RSV hospitalisations significantly reduce the total costs. • Newborn passive immunisation strategies may be still cost-effective despite age shift. Preventive measures applied during the COVID-19 pandemic have modified the age distribution, the clinical severity and the incidence of Respiratory Syncytial Virus (RSV) hospitalisations during the 2020/21 RSV season. The aim of the present study was to estimate the impact of these aspects on RSV-associated hospitalisations (RSVH) costs stratified by age group between pre-COVID-19 seasons and 2020/21 RSV season. We compared the incidence, the median costs, and total RSVH costs from the national health insurance perspective in children < 24 months of age during the COVID-19 period (2020/21 RSV season) with a pre-COVID-19 period (2014/17 RSV seasons). Children were born and hospitalised in the Lyon metropolitan area. RSVH costs were extracted from the French medical information system (Programme de Médicalisation des Systémes d'Information). The RSVH-incidence rate per 1000 infants aged < 3 months decreased significantly from 4.6 (95 % CI [4.1; 5.2]) to 3.1 (95 % CI [2.4; 4.0]), and increased in older infants and children up to 24 months of age during the 2020/21 RSV season. Overall, RSVH costs for RSVH cases aged below 2 years old decreased by €201,770 (31 %) during 2020/21 RSV season compared to the mean pre-COVID-19 costs. The sharp reduction in costs of RSVH in infants aged < 3 months outweighed the modest increase in costs observed in the 3–24 months age group. Therefore, conferring a temporal protection through passive immunisation to infants aged < 3 months should have a major impact on RSVH costs even if it results in an increase of RSVH in older children infected later in life. Nevertheless, stakeholders should be aware of this potential increase of RSVH in older age groups presenting with a wider range of disease to avoid any bias in estimating the cost-effectiveness of passive immunisation strategies. [ABSTRACT FROM AUTHOR]

While a large literature examines the immediate and long-run effects of public health insurance, much less is known about the impacts of total program exposure on child developmental outcomes. This paper uses an instrumental variable strategy to estimate the effect of cumulative eligibility gain on cognitive and behavioral outcomes measured at three points during childhood. Our analysis leverages substantial variation in cumulative eligibility due to the dramatic public insurance expansions between the 1980s and 2000s. We find that increased eligibility improves child cognitive skills and present suggestive evidence on better behavioral outcomes. There are notable heterogeneous effects across the subgroups of interest. Both prenatal eligibility and childhood eligibility are important for driving gains in the test scores at older ages. Improved child health is found to be a mediator of the impact of increased eligibility. [ABSTRACT FROM AUTHOR]

Auditory brainstem response (ABR) testing is the gold standard for diagnosis of hearing loss in children who cannot complete behavioral audiometry. Testing under general anesthesia is often recommended when natural sleep ABR and/or behavioral audiometry are unsuccessful. This study aims to determine which demographic and patient factors serve as barriers to receiving this diagnostic testing. A retrospective chart review from an internal database of patients who underwent ABR testing under anesthesia from 2017 to 2023 was completed. Patient demographics, clinical diagnoses, dates of initial recommendation, and dates of testing were recorded. A total of 395 patients met inclusion criteria, with a median time from initial evaluation to successful ABR under anesthesia of 5.1 months (range 0.1–209 months). This time was significantly higher in patients with public insurance compared to private insurance and in patients with the following medical complexities: cardiac disease, developmental delay, neurologic disease, eye disease, and genetic syndromes not associated with hearing loss. The interval was significantly shorter in patients with abnormal ear anatomy. Patient factors, such as insurance type and certain medical diagnoses, may lead to delayed ABR testing under anesthesia and thus delayed diagnosis and management of hearing loss. This has implications for the timely care and treatment of children with hearing loss. • Children with public insurance wait longer for ABR under anesthesia (70). • There is no difference in wait time based on sex, race, ethnicity, or state (63). • Medically complex children also experience delays in obtaining ABR under anesthesia (85). • Abnormal ear anatomy diagnosis leads to earlier ABR under anesthesia (71). [ABSTRACT FROM AUTHOR]

Based on a unique repeated cross-sectional data set of school-aged children in Europe, the Middle East and North America, we analyze how children's subjective well-being is related to parents' employment status, depending on the institutional context. We find that parental unemployment is strongly negatively related to children's life satisfaction across countries and years. The effect is thereby moderated by the generosity of unemployment benefits. Exploiting across- and within-country variation, our results suggest that a higher benefit replacement rate, on average, alleviates the negative effects of fathers', but not mothers', unemployment. We further test the robustness of our results considering unemployment benefits jointly with social work norms. While the buffering effect of unemployment insurance remains, the spillover effects of paternal unemployment seem to be more pronounced in environments with stricter social work norms. [ABSTRACT FROM AUTHOR]

COVID-19 has disproportionately affected healthcare access of certain minority groups, and thus could contribute to delay in timely evaluation and management of pediatric obstructive sleep apnea (OSA). Socioeconomic status (SES) is known to affect healthcare access in pediatric otolaryngology and may also be a risk factor for OSA and its associated co-morbidities. Our primary objective is to determine the impact of COVID-19 on time to diagnosis (TTD) and time to treatment (TTT) of polysomnography (PSG)-proven moderate to severe pediatric OSA in different socioeconomic classes. Secondary objectives include determining the impact of racial and demographic factors on TTD and TTT. This is a retrospective chart review of 120 children; 60 children pre-COVID (February 2018 to February 2020), and 60 children post-COVID onset (March 2020 to March 2022). This study was performed at a pediatric teaching hospital and tertiary referral center, and involved children aged 3–17 years old with outpatient PSG-proven moderate to severe OSA. Approval was obtained from our hospital's institutional review board (IRB). There were a total of 120 children, 60 in each group. The average age was 9.5 years old; females constituted 41.6 % of the sample. TTD increased from 53.7 days pre-covid to 103 days post-COVID onset in all children (p = 0.00), 42.5 days–151.9 days in white children (p = 0.00), 38 days–142.7 days in children with high SES (p = 0.00), 32.1 days–146.5 days in children with private insurance (p = 0.00), and 65.7 days–105.8 days in children with public insurance (p = 0.04). TTT did not change significantly. Our results show that TTD of OSA and obesity in advantaged groups were affected to a greater degree than disadvantaged groups. This suggests children of all socioeconomic groups are susceptible to healthcare disparities and the COVID-19 pandemic has uncovered the vulnerability of such populations. Policymakers should consider providing more funding and support for all children, including continued funding for those with lower SES. [ABSTRACT FROM AUTHOR]

Purpose: Our purpose was to survey nationwide radiation oncology practices on their participation in, burden of, and satisfaction with the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 (MACRA) payment programs.Methods and Materials: All radiation oncology practices accredited by a national specialty organization were invited to participate in a voluntary online survey from December 2018 to January 2019. Questions focused on participation in the Merit-based Incentive Payment System (MIPS) in 2017 and 2018, as by the time of this survey, radiation oncology did not yet have a specialty-specific advanced Alternative Payment Model.Results: Of n = 705 solicited practices, n = 199 completed the survey for an overall response rate of 28.2%. Practices varied significantly in their duration of participation in MACRA programs, means of data submission, and reported improvement activities under MIPS. Forty-nine percent of respondents described being either somewhat or extremely dissatisfied with the ease of submitting measures and data in 2018. The estimated cost to the practices of compliance with MACRA was queried in bins; of users able to estimate the cost of compliance for 2018, the median reported bin was $10,001 to $20,000 (range, less than $1000-100,000 or more).Conclusions: The participation style in MACRA among radiation oncology practices varied substantially in the years 2017 and 2018. The Center for Medicare & Medicaid Services gave no precise estimates on the cost of compliance for MIPS, but estimated a $3019.47 cost of compliance with the mandated Radiation Oncology Alternative Payment Model in the 2020 Final Rule for selected practices. In this survey, respondents commonly reported the cost of compliance with MACRA significantly exceeded this estimate. [ABSTRACT FROM AUTHOR]

Introduction: This study measures effects on the receipt of preventive care among children enrolled in Georgia's Medicaid or Children's Health Insurance Program associated with the implementation of new elementary school-based health centers. The study sites differed by geographic environment and predominant race/ethnicity (rural white, non-Hispanic; black, small city; and suburban Hispanic).Methods: A quasi-experimental treatment/control cohort study used Medicaid/Children's Health Insurance Program claims/enrollment data for children in school years before implementation (2011-2012 and 2012-2013) versus after implementation (2013-2014 to 2016-2017) of school-based health centers to estimate effects on preventive care among children with (treatment) and without (control) access to a school-based health center. Data analysis was performed in 2017-2019. There were 1,531 unique children in the treatment group with an average of 4.18 school years observed and 1,737 in the control group with 4.32 school years observed. A total of 1,243 Medicaid/Children's Health Insurance Program-insured children in the treatment group used their school-based health centers.Results: Significant increases in well-child visits (5.9 percentage points, p<0.01) and influenza vaccination (6.9 percentage points, p<0.01) were found for children with versus without a new school-based health center. This represents a 15% increase from the pre-implementation percentage (38.8%) with a well-child visit and a 25% increase in influenza vaccinations. Increases were found only in the 2 school-based health centers with predominantly minority students. The 18.7 percentage point (p<0.01) increase in diet/counseling among obese/overweight Hispanic children represented a doubling from a 15.3% baseline.Conclusions: Implementation of elementary school-based health centers increased the receipt of key preventive care among young, publicly insured children in urban areas of Georgia, with potential reductions in racial and ethnic disparities. [ABSTRACT FROM AUTHOR]

This study explores the interplay between two important public programs for vulnerable children: Medicaid and the Supplemental Security Income (SSI) program. Children's public health insurance eligibility increased dramatically during the late 1990s with the launch of the Children's Health Insurance Program along with concurrent Medicaid expansions. We use a measure of simulated eligibility as an exogenous source of variation in Medicaid generosity to identify the effects of the eligibility expansions on SSI outcomes. Though increases in eligibility for public health insurance did not affect contemporaneous youth SSI applications or awards on average, expansions in coverage significantly decreased both applications and awards in states where SSI recipients did not automatically receive Medicaid. We attribute the difference in findings to the higher transactions costs associated with entering Medicaid via SSI in such states. In the long-term, increased public insurance eligibility during childhood reduces young adult SSI applications to some extent, consistent with recent findings that Medicaid coverage in youth improves adult health and economic outcomes. [ABSTRACT FROM AUTHOR]

Background This study (NCT01915888) assessed public health impact of Rotarix , GSK [RV1] vaccination. Methods Children born between 2007–2011 were identified from Truven Commercial Claims and Encounters Databases and observed until earlier of plan disenrollment or five years old. Children receiving one or two doses of RV1 during the vaccination window were assigned to incomplete and complete vaccination cohorts, respectively. Children without rotavirus (RV) vaccination (RV1 OR RotaTeq, Merck & Co., Inc. [RV5]) were assigned to the unvaccinated cohort. Claims with International Classification of Disease 9th edition (ICD-9) codes for diarrhea and RV infections were identified. First RV episode incidence, RV-related and diarrhea-related healthcare resource utilization were compared. Multivariate Poisson regression with generalized estimating equations was used to generate 95% confidence intervals (CIs) around incidence rate ratios (IRR) between cohorts while adjusting for gender, age and calendar year. Mean costs for first RV and diarrhea episodes were calculated with adjustment for gender and birth year; bootstrapping was used to determine statistically significant differences between cohorts. Results Incidence of first RV episodes was significantly reduced in complete and incomplete vaccination cohorts compared to the unvaccinated cohort (IRR = 0.17 [95%CI: 0.09–0.30] and IRR = 0.19 [95%CI: 0.06–0.58], respectively). RV-related inpatient, outpatient and emergency room (ER) visits were significantly lower for complete vaccination versus unvaccinated cohort. Diarrhea-related inpatient and ER visit rates were significantly lower for complete vaccination versus unvaccinated cohorts; outpatient rates were similar. RV-related and diarrhea-related resource utilization rates were significantly lower or no different for incomplete vaccination versus unvaccinated cohort. Compared with unvaccinated children, adjusted mean cost for first RV episode and first diarrhea episode per 1000 persons was $11,511 (95%CI: $9855-$12,024) and $46,772 (95%CI: $26,268-$66,604) lower, respectively, for completely vaccinated children. Conclusions RV1 vaccination confers benefits in reduction of RV incidence, RV- and diarrhea-related healthcare resource utilization, and RV- and diarrhea-related healthcare costs. [ABSTRACT FROM AUTHOR]

Question prompt lists (QPLs) have been effective at increasing patient involvement and question asking in medical appointments, which is critical for shared decision making. We investigated whether pre-visit preparation (PVP), including a QPL, would increase question asking among caregivers of pediatric patients with undiagnosed, suspected genetic conditions. Caregivers were randomized to receive the PVP before their appointment (n = 59) or not (control, n = 53). Appointments were audio-recorded. Transcripts were analyzed to determine questions asked. Caregivers in the PVP group asked more questions (Mean PVP = 4.36, SD PVP = 4.66 vs. Mean control = 2.83, SD control = 3.03 , p = 0.045), including QPL questions (Mean PVP = 1.05, SD PVP = 1.39 vs. Mean control = 0.36, SD control = 0.81, p = 0.002). Caregivers whose child had insurance other than Medicaid in the PVP group asked more total and QPL questions than their counterparts in the control group (ps = 0.005 and 0.002); there was no intervention effect among caregivers of children with Medicaid or no insurance (p s = 0.775 and 0.166). The PVP increased question asking but worked less effectively among traditionally underserved groups. Additional interventions, including provider-focused efforts, may be needed to promote engagement of underserved patients. Patient/family-focused interventions may not be beneficial for all populations. Providers should be aware of potential implicit and explicit biases and encourage question asking to promote patient/family engagement. • A question prompt list increased question asking among pediatric patient caregivers. • But the question prompt list worked less effectively among underserved groups. • Additional interventions are needed to ensure research benefits diverse populations. • Improving engagement of underserved patients also requires changes by providers. [ABSTRACT FROM AUTHOR]

Background Despite expansions in public health insurance, many children remain uninsured or experience gaps in coverage. Community health centers (CHCs) provide primary care to many children at risk for uninsurance and are well-positioned to help families obtain and retain children's coverage. Recent advances in health information technology (HIT) capabilities provide the means to create tools that could enhance CHCs' insurance outreach efforts. Objective To present the study design, baseline patient characteristics, variables, and statistical methods for the Innovative Methods for Parents And Clinics to Create Tools for Kids' Care (IMPACCT Kids' Care) study. Methods/design In this mixed methods study, we will design, test and refine health insurance outreach HIT tools through a user-centered process. We will then implement the tools in four CHCs and evaluate their effectiveness and barriers and facilitators to their implementation. To measure effectiveness, we will quantitatively assess health insurance coverage continuity and utilization of healthcare services for pediatric patients in intervention CHCs compared to matched control sites using electronic health record (EHR) and Oregon Medicaid administrative data over 18 months pre- and 18 months post-implementation (n = 34,867 children). We will also qualitatively assess the implementation process to understand how the tools fit into the clinics' workflows and the CHC staff experiences with the tools. Conclusions This study creates, implements, and evaluates health insurance outreach HIT tools. The use of such tools will likely improve care delivery and health outcomes, reduce healthcare disparities for vulnerable populations, and enhance overall healthcare system performance. ClinicalTrials.gov Identifier: NCT02298361 . [ABSTRACT FROM AUTHOR]

Background & objectives Six million US children have no health insurance, and substantial racial/ethnic disparities exist. The design, methods, and baseline characteristics are described for Kids' H ealth Insurance by E ducating L ots of P arents (Kids' HELP), the first randomized, clinical trial of the effectiveness of Parent Mentors (PMs) in insuring uninsured minority children. Methods & research design Latino and African-American children eligible for but not enrolled in Medicaid/CHIP were randomized to PMs, or a control group receiving traditional Medicaid/CHIP outreach. PMs are experienced parents with ≥ 1 Medicaid/CHIP-covered children. PMs received two days of training, and provide intervention families with information on Medicaid/CHIP eligibility, assistance with application submission, and help maintaining coverage. Primary outcomes include obtaining health insurance, time interval to obtain coverage, and parental satisfaction. A blinded assessor contacts subjects monthly for one year to monitor outcomes. Results Of 49,361 candidates screened, 329 fulfilled eligibility criteria and were randomized. The mean age is seven years for children and 32 years for caregivers; 2/3 are Latino, 1/3 are African-American, and the mean annual family income is $21,857. Half of caregivers were unaware that their uninsured child is Medicaid/CHIP eligible, and 95% of uninsured children had prior insurance. Fifteen PMs completed two-day training sessions. All PMs are female and minority, 60% are unemployed, and the mean annual family income is $20,913. Post-PM-training, overall knowledge/skills test scores significantly increased, and 100% reported being very satisfied/satisfied with the training. Conclusions Kids' HELP successfully reached target populations, met participant enrollment goals, and recruited and trained PMs. [ABSTRACT FROM AUTHOR]

Abstract: Burn care and research have significantly improved over the past years. However, insurance coverage of such treatments does not reflect the improvements in this multi-disciplinary field. Government insurance policies in first world countries renown for burn care treatment, such as Switzerland and the United States, have not adapted to the complexity and longitudinal nature of burn care. Using case studies from both countries, we have analyzed both the institutional and policy approach to pediatric burn treatment coverage. Subsequently, by presenting the Shriners burn care model, we offer a policy recommendation to both the Swiss and the American governments to better their present legislation and infrastructure on pediatric burn coverage. [Copyright &y& Elsevier]

Summary: Introduction: A mission of the department''s State Maternal and Child Welfare Service is to organize the first checkups for children attending nursery schools. Here, we present the data of the Hauts-de-Seine department (France). Patients and method: All of the PMI physicians who carry out checkups of children aged 3 to 4 years in the nursery schools of the department, contributed in this study by random drawing a sample of 1914 children, born in 2001, who were in the 1st year of nursery school in 2004–2005. The data gathered concern the children''s way of living, their personal and family antecedents, vaccinations, the results of the clinical examination, tests of hearing, vision, and language, the existence of special health or educational programs for children with handicaps or illnesses (PPS and PAI), as well as the types of health insurance coverage the children have. Results: The median age of the children at the time of the checkups was 3 years and 8 months. Half of the children had had some kind of childcare from before the age of 1 year. Two-thirds of the children spend more than 25h a week at school. Twenty-seven percent of the children had already been hospitalized, due to accidents in 5 % of the cases. One child out of 20 lives in a nuclear family that has experienced a serious familial disease. Thirty percent of the children speak or understand a second language. Fifteen perccent of the children have poor health insurance coverage. 8.5 % of the children were overweight, 1.6 % were obese, 3.9 % were too thin. 2.5 % were in school with PAI programs,and 0.4 % with PPS programs. As a result of the checkups, 30.1 % of the children were referred (28.3 % for children who have both social security and mutual insurance), including 4.7 % for hearing tests, 13.7 % for vision, 4.4 % for dental checkups, 6.3 % for anomalies of the general examination, 2.7 % for psychological difficulties, 2.6 % for serious language difficulties. 28.9 % of the parents received advice (26.4 % for children who have both social security and mutual insurance) for psychological difficulties, language issues, DTCPH (diphtheria, tetanus, whooping cough, poliomyelitis and hemophilus) and Measles, Mumps, Rubella (MMR) vaccination boosters, and 56.1 % when we add the recommended hepatitis B vaccination. Children who are in schools in priority education zones represent 12.1 % of them. These 2 subgroups are distinguished for a large number of variables, which reflect the very early appearance of social inequalities in terms of health care. Children who went to the Child Welfare Service represented 35 % of the sample, children who are in schools in priority education zones represent 12.1 % of them. Conclusion: The complete and systematic medical exam for children in nursery school at the age of 3–4 years old, the key age for screening, give occasion to appreciate global children''s health. There should be thinking on the national level about how to group the results of the departments. [Copyright &y& Elsevier]

The article discusses a study to describe trends and patterns in antipsychotic treatment of 2 to 5-year-old privately insured children. It involves a trend analysis of antipsychotic medication use of privately insured children with 12 months of continuous service enrollment in 1999 to 2001 or 2007. Furthermore, it shows that the annual rate of antipsychotic use per 1,000 children increased from 0.78 to 1.59, but less than one half of the children received formal mental health services.

Abstract: Objective: Caring for neonates with major congenital anomalies has significant financial implications for the treating institution, which can be positive or negative depending on whether the patient has insurance. We hypothesized that insured affected neonates born in non–children''s hospitals would be more likely to be treated on site, whereas uninsured neonates would be more likely to be transferred. Patients and Methods: We used the Kids'' Inpatient Database to study neonates with congenital anomalies who were born in US non–children''s hospitals. We performed bivariate analysis using the χ 2 test and adjusted for covariates with multiple logistic regression. Results: Uninsured patients were 2.57 (95% confidence interval, 1.83-3.62) times more likely to be transferred compared with patients with private insurance or Medicaid, after adjusting for patient and hospital characteristics. This trend increased over time between 1997 and 2006. Conclusions: The current reimbursement structure in the United States incentivizes non–children''s hospitals to retain insured patients with congenital anomalies and transfer uninsured patients with these same anomalies. This places a disproportionate financial burden on children''s hospitals while paradoxically causing insured infants to be cared for at hospitals that may not be best equipped to provide complex care. [Copyright &y& Elsevier]

Pediatric intensive care is now a subspecialty of pediatric medicine. Different pathologic and physiologic processes occur in pediatric patients who require intensive care. Thus, the faculty and staffing requirement differ in many aspects from those of adult intensive care units (ICUs). In Taiwan, pediatric intensive care is relatively less developed than adult care. However, thanks to the implementation of national health insurance and increasing emphasis of children''s health, the scope and quality of pediatric intensive care has widened and rapidly improved. Research has shown that full time in-ICU staffing and patient care will result in improved outcomes for critically ill pediatric patients. In this article, we review the literature and recent advances in pediatric intensive care; we also outline the challenges arising. Special emphasis was made to the clinical context of Taiwan. [Copyright &y& Elsevier]

Access to vision care is essential for diagnosing and treating vision impairments. Gaps in health insurance coverage may prevent children from receiving vision care and lead to unmet needs for vision services. This study used deidentified data on children 3-17 years of age from the 2016-2019 National Survey of Children's Health. The primary outcome was caregiver-reported unmet needs for vision care in the previous 12 months. Based on a sample of 106,876 children, 3.8% of US children had a recent gap in coverage, and 5.0% lacked insurance in the entire year leading up to the survey. The estimated population prevalence of caregiver-reported unmet needs for vision care was 0.7%. However, children with gaps in coverage had almost 19-fold higher odds of having caregiver-reported unmet vision care needs (OR = 18.7; 95% CI, 11.5-30.2; P < 0.001), and children with a complete lack of coverage also had a ninefold higher odds of caregiver-reported unmet vision care needs (OR = 9.5; 95% CI, 5.5-16.4; P < 0.001), compared to children with year-round private coverage. In the 2018-2019 data, results were similar when analyzing completion of routine vision testing within the past 12 months. Children with gaps in coverage had the highest likelihood of caregiver-reported unmet vision care needs compared with children with year-round coverage or children with year-round lack of coverage.▪ [ABSTRACT FROM AUTHOR]

• Cash transfers (CT) are proposed as a nutrition-sensitive strategy to address malnutrition. • This study documents the impacts of a Ghanaian CT paired with health insurance on malnutrition and its determinants. • We find no impact on nutritional outcomes, food intake and child health, but a positive effect on household food security. • Meal frequency decreased among beneficiary children, suggesting an important role for intra-household dynamics. • Integrated programmes that simultaneously address underlying determinants of malnutrition need to be further examined. Child malnutrition remains a major global public health issue, with 155 million children under five stunted and 52 million children wasted. Social protection, in the form of cash transfer programmes, has been identified as a potential nutrition-sensitive intervention to address malnutrition in early childhood. This study documents the impacts on young child nutrition outcomes and underlying determinants of a Ghanaian cash transfer programme paired with health insurance fee exemptions, targeted to pregnant women and infants under one year. We use data from a 24-month quasi-experimental impact evaluation which exploits the fact that households were selected into the programme based on a continuous programme eligibility index. Using a difference-in-difference approach, our study finds no main treatment effect on nutritional outcomes. Household-level food security improved, yet child meal frequency decreased, suggesting an important role for the intra-household allocation of resources. We conclude that cash alone is unlikely to yield impacts on young child nutrition outcomes and integrated programmes that aim to address multiple underlying determinants at the same time need to be further examined, including effects on the intra-household division of resources. [ABSTRACT FROM AUTHOR]

Social programs and mandates are usually studied in isolation, but unintended spillovers to other areas can impact individual behavior and social welfare. We examine the presence of spillovers from health care policy to the education sector by studying how health insurance coverage affects the education of students with Autism Spectrum Disorder (ASD). We leverage a state mandate that increased insurance coverage of ASD-related services, which often are provided by both the private sector and within public schools. The mandate primarily affected coverage for children with private health insurance, so we proxy for private insurance coverage with students' economic disadvantage status and estimate effects via triple-differences. While we find little change in ASD identification, the mandate crowds-out special education supports for students with ASD. A lack of short-run impact on achievement supports our crowd-out interpretation and indicates that the mandate had little net effect on the academic achievement of ASD students. [ABSTRACT FROM AUTHOR]

• This study analyzes the impact on formal employment caused by the extension of health insurance to formal workers' children. • The impact on formal employment is 2 percentage points, a variation of 8 above the pre-reform level. • The increase of formal employment was driven from unregistered to registered employment. • The impact was greater for parents with younger children. • These results have implications for designing social security reforms. This research focuses on the 2009 and 2010 Ecuadorian reforms that included formal workers' children under 18 years old in the health insurance coverage. The study analyzes the impact on formal Ecuadorian employment caused by the extension of health insurance coverage to the workers' children, using a difference-in-differences approach and repeated cross-sections of household surveys. Evidence reveals that, after the policy reform, individuals who had children were more likely to become formal workers than childless individuals. The impact is about 2 percentage points (about 8% above the pre-reform level). The result was mainly driven from unregistered to registered employment, and by parents with younger children. [ABSTRACT FROM AUTHOR]

We apply a mixed-payer economy model to study the effects of changes in the generosity of children's public health insurance programs - measured by Medicaid and Children's Health Insurance Program income thresholds - on substance use disorder (SUD) treatment provider behavior. Using government data on specialty SUD treatment providers over the period 1997-2011 combined with a two-way fixed-effects model and local event study, we show that increases in the generosity of children's public health insurance induce providers to participate in some, but not all, public markets. Our effects appear to be driven by non-profit and government providers. Non-profit providers also appear to increase treatment quantity slightly in response to coverage expansions. [ABSTRACT FROM AUTHOR]

The cost of health care insurance is one of the most important factors in the health care development. To establish a better health care system, there is a need to estimate the cost of health insurance. The prediction of the cost is one possibility to improve health care development. There is a need for more advanced methods other than traditional regression approaches, because the prediction of the health insurance costs are now a big data problem. To simplify the prediction process in this study, a selection procedure was performed to identify the most important factors for the prediction of the health care insurance costs. Artificial neural network, namely adaptive neuro fuzzy inference system (ANFIS), was used for the identification procedure. ANFIS architecture was employed to model nonlinear relationships between data samples. Five input factors were considered in the analyzing (age of primary beneficiary, insurance contractor gender, Body mass index, Number of children covered by health insurance, and smoking). The obtained results showed that smoking has the highest impact on the cost of health insurance. Moreover, prediction accuracy is acceptable and could be used for future management of health care development. • Costs of health insurance in health care development. • To establish the best health care system. • To estimate the cost of health insurance. • Prediction of the cost of health insurance. [ABSTRACT FROM AUTHOR]

Infant clinical outcomes and expenditures were assessed using medical claims in the 12 months following birth and compared based on presence of maternal preeclampsia. Infant all-cause total health care expenditures ($34,034 vs. $15,067) and inpatient ($28,295 vs. $10,383) costs in the first year of life were significantly higher in infants with maternal preeclampsia; outpatient ($5,739 vs. $4,426) and pharmacy costs ($436 vs. $258) were also significantly higher (p<0.001 for all). [Extracted from the article]

• Ghana's National Health Insurance Scheme improves child health on average. • However, four out of the ten regions did not see significant benefits from the scheme. • Benefits are concentrated in lower-income households in regions with a high quality of care. • Further evidence points to the importance of health care utilization to explain these results. This paper assesses whether health insurance is successful in improving health. More specifically, it investigates whether a same health insurance scheme has differentiated impacts on children depending on the way it is implemented and on the characteristics of the beneficiaries. To do so, I analyze the case of Ghana's National Health Insurance Scheme that provides free coverage for children and has decentralized operations. I exploit the Multiple Indicator Cluster Survey of 2011 and I use propensity score matching to account for selection in the scheme. The study finds that, even though the NHIS is successful in improving health outcomes among insured children in Ghana, gains are not shared equally across regions. To understand this regional heterogeneity, mechanisms are investigated. The positive impact of health insurance is concentrated among the lower-income households in regions with a high quality of public health care. Further evidence points to the importance of health care utilization to explain these results. This paper sheds a new light on the mixed results of the literature on the impact of health insurance on health outcomes. It provides an understanding of the sources of the heterogeneous impact of a National Health Insurance Scheme and highlights the importance of context and implementation as drivers of its effectiveness. Such evidence is relevant for both the evaluation and monitoring of existing health care schemes and for the implementation of new large-scale public policies. [ABSTRACT FROM AUTHOR]

27% of children under age 6 were using private health services with full or partial fee for services although they have been granted health insurance coverage by the Vietnamese government if they go to public providers. Private healthcare services are more likely to be used by children who are living in urban areas while public healthcare services are preferred by children living in the Midland and Mountainous area. [Extracted from the article]