The impact of managed care on children's access, satisfaction, use, and quality of care.

OBJECTIVE: To examine the impact of managed care on children's access, satisfaction, use, and quality of care using nationally representative household survey data. DATA SOURCE: The 1996 Medical Expenditure Panel Survey (MEPS). STUDY DESIGN: Bivariate and multivariate analyses are used to detect independent effects of managed care on access, satisfaction, utilization, and quality of pediatric health services. DATA COLLECTION/EXTRACTION METHODS: Data were obtained from rounds 1, 2, and 3 of the 1996 MEPS. MEPS collects data on health care use, insurance, access, and satisfaction, along with basic demographic and health status information for a representative sample of the U. S. civilian, noninstitutionalized population. Our sample consists of 5,995 children between the ages of 0 and 17. FINDINGS: Among the 18 outcome indicators examined, the bivariate analysis revealed only three statistically significant differences between children enrolled in managed care and children in traditional health plans: children enrolled in managed care were more likely to receive physician services, more likely to have access to office-based care during evening or weekend hours, and less likely to report being very satisfied with overall quality of care. However, after controlling for confounding factors, none of these differences remained statistically significant. CONCLUSIONS: Our findings suggest that there are no statistically significant differences in self-reported outcomes for children enrolled in managed care and traditional health plans. This conclusion is provisional, however, because of limitations in the data set.

Follow-up of newborns and their mothers after early hospital discharge.

As postpartum hospital stays have become increasingly shorter, more attention has been focused on the importance of routine postdischarge follow-up for newborns and mothers. Recent guidelines and legislation, however, include few specifics on how follow-up services should be provided. Based on the authors' review of the recent literature, it was concluded that the research to date provides little useful information to guide follow-up practices under current conditions. Additional studies that focus on postdischarge follow-up, rather than on length of hospital stay, are needed to provide the basis for more specific practice guidelines.

Gender differences in the sexual behavior of latino adolescents: an exploratory study in a public high school in the san francisco bay area.

PURPOSE: The purpose of this study was to examine factors associated with sexual behavior among urban, first-generation Latino adolescents. METHODS: Data were collected with self-administered questionnaires on 176 (98 girls and 78 boys) Latino high school students between the ages of Fifteen and nineteen years, of whom 76 percent were born in Latin America and 34 percent had lived in the United States for two years or less. The outcome variables measured three levels of sexual activity, defined as: sexual abstinence, "making out" (kissing passionately, or kissing "using one's tongue"), and sexual intercourse. The key predictors were gender and acculturation. Other variables included information on socio-demographics, self and body-image, college aspirations, and family structure/relationships. Stratified analysis was conducted for each gender. RESULTS: Twenty percent of boys and 27 percent of girls were abstainers. Whereas girls were more likely than boys to "make out" only (47% vs. 26%), boys were more likely to engage in sexual intercourse (54% vs. 26%). For girls, there was a negative association between making out and maternal punishment, feeling close to both parents and paternal love. Sexual intercourse was inversely associated with having educational goals beyond high school and presence of parental love, and positively correlated with age and maternal communication about sex. In boys, the predictors of "making out" were feeling close to both parents and Spanish language spoken with friends, and for sexual intercourse the significant predictors were feeling close to both parents, presence of an older sister, and body-image. CONCLUSIONS: The results indicate that family structure and relationships, personal characteristics, and acculturation play important but different roles in the sexual development of Latino adolescent girls and boys. Sex education curricula should take these gender and family influences into account.