Effectiveness of compliance with pediatric preventive care guidelines among Medicaid beneficiaries.

OBJECTIVE: Because research has not confirmed a relationship between compliance with health supervision in infancy and improved health outcomes, we examined the association between adherence to prevailing guidelines for periodic health supervision and adverse health outcome indicated by incidence of avoidable hospitalizations. METHODS: This was a historic cohort study of 308 131 children enrolled in Medicaid at birth in California, Georgia, and Michigan in 1990 using Medicaid records linked across 3 years. We used avoidable hospitalizations as indicators of health in a survival analysis. The analysis used variables that represented completeness and timeliness of well-child visits and immunizations using AAP guidelines for health supervision as the gold standard. RESULTS: When the children in this cohort were up-to-date for age on their schedule of well-child visits, they were less likely to have an avoidable hospitalization (race, illness, and level of poverty adjusted hazard ratios 0.52 [95% confidence interval (CI): 0.50-0.55] in California, 0.54 [95% CI: 0.50-0.55] in Georgia, and 0.7 [95% CI: 0.69-0.79] in Michigan). Among children who were not up-to-date with well-child visits, a sporadic preventive care visit conferred a mild benefit. Immunizations and race/ethnicity had no consistent relationship with incidence of avoidable hospitalizations. CONCLUSIONS: A series of well-child visits maintained during the first 2 years of life has a positive effect on health outcomes as indicated by a decrease in avoidable hospitalizations among poor and near-poor children, regardless of race, level of poverty, or health status. National efforts to improve the quality of child health services for young children should focus on increasing compliance with periodic preventive care for young children in addition to improving immunization levels.

Labor-force participation and earnings of SSI disability recipients: a pooled cross-sectional times series approach to the behavior of individuals.

This article examines two important aspects of work behavior, labor-force participation, and earnings among persons who since 1976 have become entitled to SSI disability benefits and received payments for a full calendar year or longer during the intervening time period. A data set was developed containing the records of a random sample of all individuals who had ever received Supplemental Security Income (SSI) disability benefits and matched to earnings records maintained by the Social Security Administration (SSA). A multivariate analysis based on a pooled cross-sectional time series approach was employed using individual-level data to first estimate the probability of an SSI recipient performing work and then to estimate, among those who worked, the level of earnings. For this analysis, the SSI population was divided into three distinct groups based on their diagnosis: the nondevelopmentally disabled, the developmentally disabled (other than the mentally retarded), and the mentally retarded. The analysis provides information about the impact that individual characteristics (such as age, education, diagnosis, and so forth) play in the decision to work and in determining the level of earnings. The analysis also addresses yearly variations in labor-force participation and earnings.

The development of a new geographic coding system for the Continuous Work History Sample.

This article describes the statistical development of the geographic coding system used to identify worker location for the Continuous Work History Sample. The new system--which is planned for implementation for data year 1993--will provide more accurate geographic distributions of workers within a residence concept than the old system could provide within an employer location concept. The article also presents the results of a pilot study that tested the operational aspects of the new system. The results provide some preliminary estimates of the effect of the revised codes on the geographic distribution of workers.

Sampling variance estimates for SSA program recipients from the 1990 Survey of Income and Program Participation.

Since 1987 the Social Security Administration (SSA) has published a special set of tabulations on SSA program recipients in the Annual Statistical Supplement to the Social Security Bulletin using data derived from the Census Bureau's Survey of Income and Program Participation (SIPP). Estimates of sampling errors pertaining to these tabulations were derived from the 1984 SIPP panel. This article provides updated sampling error estimates for the 1990 SIPP panel to be used in conjunction with the SIPP-based tabulations provided in the Annual Statistical Supplement for 1992 and 1993. The computational approach is essentially the same as that used in the earlier analysis. Sampling variances are estimated by half-sample replication using the pseudo stratum and half-sample codes available on SIPP public use data files. Generalized tables of standard errors are provided for all SSA program participants. An appendix provides detailed specifications about the calculations. In order that it be self-contained, this article repeats much of the methodological exposition in the previous article that appeared in the October 1988 issue of the Social Security Bulletin.

A note on sampling variance estimates for Social Security program participants from the Survey of Income and Program Participation.

The Census Bureau's Survey of Income and Program Participation (SIPP) provides data that can be used to study the characteristics of Old-Age, Survivors, and Disability Insurance (OASDI) and Supplemental Security Income (SSI) program participants. It is important that estimates of sampling errors accompany such studies because the estimates may have large sampling errors due to the small number of sample cases available for specific analyses. The generalized sampling variances provided by the Census Bureau did not identify separately either program's participants and, therefore, do not pertain directly to analyses of these groups. This article describes an approach to the direct computation of sampling variances for OASDI and SSI program participants. The approach uses the pseudo stratum and half-sample codes available in SIPP public use data files. A table of generalized standard errors is constructed for participants of both programs aged 18 or older. Generalized standard errors could not be computed for child beneficiaries under age 18 because of a wide variation of design effects across subpopulation estimates.