ABSTRACT
School-based health centers (SBHCs) are a policy innovation designed to increase health care access among youth. The centers offer primary and acute care, often to underserved populations. We describe SBHCs, trace their history, and analyze the three great political challenges they face: moral opposition triggered by concern about reproductive health services in schools; funding in a managed care era; and partisan state politics. We show how the centers have been meeting these challenges. Finally, we consider the prospect of this innovation going to scale across the nation.
Subject(s)
Adolescent Health Services/organization & administration , Community Health Centers/supply & distribution , Comprehensive Health Care/organization & administration , School Health Services/organization & administration , Adolescent , Adolescent Health Services/economics , Community Health Centers/economics , Humans , Organizational Innovation , Politics , School Health Services/economics , State Government , Third-Party Consent , United States , Violence/prevention & controlABSTRACT
Risk contracting by states for coverage of previously uninsured populations has been hampered by uncertainty regarding likely claims experience. This study reports on the utilization experience of two state programs offering subsidized coverage in commercial managed care organizations to low-income and previously uninsured people. Program participants used services similarly to people enrolled through large employer benefit plans. There was no evidence of pent-up demand or an unusual level of chronic illness. Similarly, there was little evidence of underutilization, although dissatisfaction and reported barriers to service were more frequent among nonwhite enrollees.
Subject(s)
Contract Services/statistics & numerical data , Insurance Selection Bias , Managed Care Programs/statistics & numerical data , Medically Uninsured , State Health Plans/statistics & numerical data , Adolescent , Adult , Eligibility Determination , Female , Health Benefit Plans, Employee/statistics & numerical data , Health Services Accessibility/standards , Health Services Research , Humans , Maine , Male , Middle Aged , Multivariate Analysis , Patient Satisfaction/statistics & numerical data , Socioeconomic Factors , United States , WashingtonSubject(s)
Health Care Reform , State Health Plans/organization & administration , Universal Health Insurance/legislation & jurisprudence , Community Participation , Eligibility Determination , Employee Retirement Income Security Act , Health Services Accessibility , Maine , Policy Making , State Health Plans/statistics & numerical data , United States , WashingtonABSTRACT
To evaluate the impact of Maine's Medicaid waiver for the mentally retarded, baseline and 1-year followup data were obtained for 191 waiver clients and a comparison population of 115 persons excluded from the program because of enrollment limits. Program effectiveness was evaluated through measures of changes in clients' personal and community living skills. Medicaid and other data were used to establish individual and aggregate costs. It was found that the waiver program is a cost-effective alternative to intermediate care placements but that client screening is necessary to limit the enrollment of clients not at risk of institutional placement.
