Health and social service utilization among elderly immigrants from the former Soviet Union.

PURPOSE: To explore factors that affect health and social service use among elderly Russian immigrants from the perspectives of the elders, their adult caregiving children, and the health and social service professionals who serve them. METHODS: A qualitative, case-oriented study design was used and 17 elderly Russian immigrants, 8 adult caregiving children, and 15 health professionals were interviewed in the Boston area in 1998. Perceptions about the patterns of and reasons for Russian elders' health and social service use were summarized through content analysis of the interview data. FINDINGS: Participants across groups perceived extensive service use by elderly Russian immigrants. Life circumstances associated with immigration, cultural norms and beliefs, and structural characteristics of the local Russian immigrant community accounted for service use. CONCLUSIONS: Findings indicate that providing support for depression and loneliness associated with immigration, educating immigrants about the role of primary care providers in the US as well as realistic expectations for American medicine, and managing care to decrease the use of unnecessary services would facilitate appropriate service use among elderly Russian immigrants.

Impact of the Oregon Health Plan on children with special health care needs.

OBJECTIVE: Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with special health care needs fare under such programs. Of particular concern is the ability of such children to navigate a managed care system and gain access to specialty and other services. This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan. METHODOLOGY: Telephone surveys were conducted with a sample of parents of children enrolled in the Oregon Health Plan. Three groups of children were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs. Descriptive and multivariate analyses were conducted to determine the impact of Medicaid managed care on access and satisfaction. RESULTS: Children with disabilities in managed care plans did not experience any more difficulty accessing needed specialty care than did those without special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabilities remaining in fee-for-service. CONCLUSIONS: Unlike SSI children with disabilities, children who were not SSI-eligible but had asthma seemed to have difficulty obtaining some services. These children were not eligible for the same consumer protections afforded SSI children by Oregon. If states want to enroll all children with special health care needs into managed care programs, they must develop mechanisms for identifying such children and ensuring that they receive medically necessary services.

Covering uninsured adults through Medicaid: lessons from the Oregon health plan.

The Oregon Health Plan (OHP), Oregon's section 1115 Medicaid waiver program, expanded eligibility to all residents living below poverty. We use survey data, as well as OHP administrative data, to profile the expansion population and to provide lessons for other States considering such programs. OHP's eligibility expansion has proved a successful vehicle for covering large numbers of uninsured adults, although most beneficiaries enroll for only a brief period of time. The expansion population, particularly childless adults, is relatively sick and has high service use rates. Beneficiaries are also likely to enroll when they are in need of care.