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Show Table 1. Ambulatory-Care Sensitive Hospitalization Rates in Utah, U.S., and Valencia, Spain1 (rates per 10,000 children) Primary Diagnosis Utah 1992-1995 U.S. 1988 Valencia, Spain Massachusetts Males Massachusetts Females Maryland Males Maryland Females Chronic Conditions Asthma 12.1 30.9 4.7 37.8 25.9 34.3 25.3 Diabetes 3.8 5.8 0.2 1.4 2.4 1.9 3.1 Acute Conditions Cellulitis 3.4 4.7 2.9 6.3 4.0 5.1 3.9 Pneumonia 16.4 27.5 10.7 19.7 16.2 24.1 19.9 Immunizable Conditions 0.7 0.9 0.4 0.2 0.2 <0.1 0.2 conjectured that greater reduction of ACS hospitalization rates would be evident sooner for acute conditions, which would be less dependent on the child's past access to care. Such conditions might include hospitalizations for pneumonia and dehydration. An advantage of use of the ACS hospitalization rates as one type of outcome measure in an evaluation of the CHIP program is their ready availability from the Utah Office of Health Data Analysis. Measurement of the Utah CHIP program's effect on ACS hospitalization rates would require certain data to be maintained by the Utah Department of Health. This would include a way to identify the uninsured, the Medicaid population, and those who are privately insured, both on hospital discharge data records and as total population by years of age, gender and zip code or county of residence. The CHIP proposal plans to collect adequate population data. However, the hospitalization data themselves lack data on race and ethnicity in over 95% of hospital discharges reported during 1992-1995. In order to discern program effects for all Utahns using these administrative data, steps to obtain this information accurately would be useful. Conclusions A professed goal of the CHIP program is to improve access to health care services for enrolled Utah children. Child ACS hospitalization rates represent one readily obtainable set of indicators of the access of a population to primary care. Insurance coverage is one means to reduce economic access barriers, and these indicators appear sensitive to it. For example, Canada and Spain have national health insurance, and their ACS hospitalization rates are lower and/or less correlated with socioeconomic status than American ACS hospitalization rates. In addition, the proportion of hospitalizations which are ACS has been observed by Billings to be greater for the uninsured as compared to an American Medicaid population. Therefore, if the Utah CHIP is effective in increasing childrens' access to primary care, it is reasonable to anticipate a drop in the child ACS hospitalization rate and potentially the proportion of enrolled child hospitalizations which are for ACS conditions. ACS hospitalization rates may thus represent one readily available, viable tool among others in an evaluation of the health effects of the Utah CHIP program. References Agency for Health Care Policy and Research (1996). Technical Overview of Consumer Assessment of Health Plans (CAHPS) (97-rO13). Rockville, MD: U.S. Department of Health and Human Services. Anton, T. J. (1997). New federalism and intergovernmental fiscal relationships: the implications for health policy. J. Health Polit Policy Law, 22(3), 879-896. National Committee for Quality Assurance. (1998). HEDIS 3.0 . Washington, D.C. Billings, J., Anderson, G. M, & Newman, L. S. (1996). Recent Findings on Preventable Hospitalizations. Health Affairs, 15(3), 239-249. Billings, J., & Teicholz, N. (1990). Uninsured Patients in District of Columbia Hospitals. Health Affairs, 9 (Winter), 158-165. Billings, J., Zeitel, L., Lukomnik, J., Carey , T., Blank, A. E., & Newman, L. (1993). Impact of socioeconomic status on hospital use in New York City. Health Aff Millwood, 12(1), 162-173. Bindman, A. B., Grumbach, K., Osmond, D., Komaromy, M., Vranizan, K., Lurie, N., Billings, 54 |
