PubMed · 6560389
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M B Gorke-Felice. Practice management. Practitioner/proprietor.. https://pubmed.ncbi.nlm.nih.gov/6560389/
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OBJECTIVE: To estimate the prevalence and length of gaps in health insurance coverage and their effect on having a regular source of care in a national sample of preschool-aged children. DESIGN: Follow-up survey of a nationally representative sample of 3-year-old children in the US population by phone or personal interview. PARTICIPANTS: A total of 8129 children whose mothers were interviewed for the 1991 longitudinal Follow-up to the National Maternal and infant Health Survey. MAIN OUTCOME MEASURES: Report of any gap in health insurance for the children, the length of the gap, and the number of different sites where the children were taken for medical care as a measure of continuity of a regular source of care. RESULTS: About one quarter of Us children were without health insurance for at least 1 month during their first 3 years of life. Over half of these children had a health insurance gap of more than 6 months. Less than half of US children had only one site of care during their first 3 years. Children with health insurance gaps of longer than 6 months were at increased risk of having more than one care site (odds ratio = 1.52; 95% confidence interval, 1.19 to 1.96). This risk further increased when an emergency treatment was discounted as a multiple site of care. CONCLUSIONS: Having a gap in health insurance coverage is an important determinant for not having a regular source of care for preschool-aged children. This finding is of concern, given the sizable percentage of children in the United States who lacked continuous health care coverage during a critical period of development.
OBJECTIVES: This study evaluates New York City's Child Immunization Day (1993), with emphasis on the cost and effects of a mass campaign and the use of strategies from developing nations in an inner-city context. METHODS: The methodology was designed to (1) document the planning and implementation process, (2) analyze the number and characteristics of children in the target group, and (3) estimate costs. RESULTS: Neither the social mobilization nor the political will that characterize successful campaigns in developing nations occurred in New York City's campaign. Despite substantial time and effort from both private and public agencies, turnout for the event was low. In total, 2647 families and 5237 children were assessed for health care and insurance needs, 2949 children were immunized at a cost of about $279 per immunized child, and 7236 vaccines were administered. CONCLUSIONS: The differences between inner cities and developing nations have a bearing on strategies used in planning and implementing mass campaigns. New strategies need to be forged from a blending of these contexts to create effective campaigns in industrialized inner cities.
The high infant mortality rate in the United States, especially in urban areas, remains a major federal concern. Four strategies for reducing infant mortality in cities participating in the federal ¿Healthy Start¿ are reducing high-risk pregnancies; reducing the incidence of low birthweight and preterm births; improving birthweight-specific survival; and reducing specific causes of post-neonatal mortality. Estimates of the impact of known interventions indicate that the reduction in infant mortality would be large for only one strategy: improving birthweight-specific survival. Most interventions yield a 2 percent reduction, or less, in mortality and when combined, would amount to about 30 percent. This strategic model provides a realistic framework to assess the impact of the Healthy Start demonstration and is useful in highlighting the interventions most likely to reduce infant mortality in a population.