We used geocoded addresses from enrollment files to obtain data on each family’s census block group from the 2000 United States Census. Other covariates included clinical and neighborhood-level socioeconomic variables. The primary predictor variable was whether the child was switched to an HDHP or remained in a traditional plan. Based on the child’s age at the end of the baseline and follow-up periods, we calculated the number of well-child visits received and the number recommended for that 12-month period. 22 As American Academy of Pediatrics recommendations do not include visits at age 7 or 9 years, we did not require a well-child visit for children aged 7.00 to 9.99 years. For the yearly visits after the 24-month visit, we allowed the child to have a visit anytime over a 12-month period. 21 However, a child receiving a visit more than 1 month late could still end up receiving the recommended number of visits by the end of the 12-month period.
In calculating the minimum number of visits recommended, we allowed a 1-month grace period for receiving visits through the 24-month visit. We determined the minimum number of well-child visits that should be received over the prior 12 months ( Table 1). 20-22 Well-child visits were identified from claims data as having either (1) one of the following Current Procedural Terminology codes: 99381, 99382, 99383-99385, 99391, 99392, 99393-99395, or 99432 or (2) one of the following International Classification of Diseases, Ninth Revision ( ICD-9) codes: V20.2, V70.0, V70.3, V70.5, V70.6, V70.8, or V70.9.23 Based on the child’s age and recommendations of the American Academy of Pediatrics, 24 The primary outcome of interest was whether recommended well-child visits were received by a child in a 12-month period (baseline or follow-up) based on an algorithm adapted from other studies. Children younger than age 18 years on the index date were selected from this population for the study sample. Some control families were subsequently excluded if a family member no longer met the age or continuous enrollment criteria for the 24-month period around the assigned index date. Controls were assigned the same index date as their matched HDHP family. The date the family switched to an HDHP was assigned as the index date separating the baseline and follow-up periods. For each HDHP family, we selected 8 control families whose employer continued to offer only a traditional HMO plan control families were matched only on the basis of contemporaneous enrollment periods and were otherwise randomly selected. We selected all eligible families that were switched by the employer to an HDHP. National data suggest that enrollees without a choice of plans constitute half of the population in HDHPs. In this way, the choice to switch to an HDHP (or to remain in a traditional HMO) was made at the employer level, not at the employee level. To reduce selection effects, we limited our study to families who were insured through employers offering only 1 type of health plan that is, they did not offer a choice between Harvard Pilgrim and other health plans, or a choice between different types of Harvard Pilgrim plans (89% of families in this population). We identified a control group of families with at least 1 child aged 18 years or younger who remained in a traditional Harvard Pilgrim HMO plan for at least 24 months. Methods: We selected children aged 65 years of age or (2) a family member did not have continuous enrollment through the same employer for the 24-month period. Study Design: Pre-post comparison between groups. If you would like it faxed to a school, daycare, or other facility, we will need a signed consent to share your child's health information.Objective: To examine how enrollment in highdeductible health plans (HDHPs) affects use of well-child visits relative to traditional plans, when preventive care is exempt from the deductible. Otherwise, we are happy to process them in 5-7 business days. Check it out you might even see your doctor featured in a video!įorms: Remember to request any forms you may need at your visit. We partner with 292-BABY, a valuable resource with hundreds of quality health education videos. Signs of dehydration, such as a decrease in wet diapers over a 24-hour period, dry mouth, lack of tears when crying, tiredness, or sunken eyes.Fever with any of the following symptoms:.Six or more loose stools in a 24 hour period.
We suggest that parents should always contact the clinic when a child experiences any of the following symptoms: We are happy to provide telephone advice. Please call anytime you are uncomfortable about how your child is feeling.
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