Health Maintenance

The diagnosis of a chronic illness may be made at time.Some disorders are diagnosed before birth,many in the newborn period,and others during childhood.After diagnosing a chronic illness,the next step is to address the medical issues.Who will provide care?Where will it be provided?What is the best way to access the system?When the diagnosis is made,various provider options are available but any choices made are likely to changes as time goes on.
The changing environment of health care in the United States makes it difficult for the patient,who is now the consumer,and the family to understand all the choices.Managed Care Organizations (MCOs) have been established to provide optimal health care while at the same time reducing costs.MCOs cover a multitude of approaches to providing care.They include Health Maintenance Organizations (HMOs), which include Kaiser Permanent and a series of groups of physicians or providers who are united together.Examples includes PPOs, which are Preferred Provider Organizations, and IPAs which are Independent Physicians Associations.
  He barriers of access to medical care for children are financial,systems,and knowledge-based.Children with disabilities are more likely to receive physician care if they have insurance than if they do not.It would make sense that the more that health care services are needed,the more they are accessed,but in reality the poor,uninsured,minority,and single-parent children will receive less medical care.This may be because of the barriers to care as well as an unwillingness to seek care.One study showed that uninsured children received 40 percent less care than their incured counterparts.The goals ot Medicated nad Supplemental Security Insurance (SSI) programs have improved access to health care for many poor families in the last 20 years,but many more who needs care do not receive it.In addition,there are many families who utilize limited resourcess who do not need or benefit from them.
Managed care  has problems that are the result of decisions being made on the basis of cost rather than necessity.Outcome measures have been implied as justifying the sharing of cost and revenue.This does not justify withholding treatment for a specific individual who may benefit fro therapy.A treatment that has the potential to reduce costs,for example an intervention that will lower hospitalization rates,should lead to its consideration,but if it is not recognized by the payor,it may be denied because the rules say so.Medicaid benefits vary considerably from state to state and while the regulations are appropriately restrictive they are impossibly complicated and the bureaucracyso involved that they do not assure that the patient and families who need the most,get the most.Within the last few years,studies have shown that a significant proportion of children were without health insurance for 1 year, and that of the children with chronic disorders,76 percent had private insurance , 11 percent had Medicated, and 13 percent had no insurance.
There are many levels of medical care and some of the levels may be accessed more easily than others.In- and out-patient care,drugs,home care,durable medical equipment,various therapies (e.g., respiratory, physical, occupational), mental health, dental, and eye care may all have different levels of accessibility and payment.Choosing a health plan involves learning what options are available and selecting the one that has the most potential to meets the needs.If there is a child with a chronic disorder and different options are available, it is helpful to discuss this with a clinician involved with the care.Unfortunately, the selection of the health plan is often dependent on the occupation of the parent (whose employer or insurance company provides the alternatives) rather than on the needs of the child with the chronic disorder.
The additional needs pt many of the conditions described also put a burden on the health care system.Because of the complex nature of many conditions and the treatment that they require, there is a financial burden as well as a systems problem.Multiple specialist,surgical procedures, and complex therapies tend to be expensive.Capitated managed care systems are not geared to providing care for small populations of medically needy children who require techonologically advanced and specialized care, which tends to be very expensive.Cost effectiveness   specialized care can be achieved but the question is where should the line be drawn as to how much care is provided and who should draw that line?In the last few years the lines have been drawn at the point where there is actually a reduction in the level of care that is provided for many patients who were able to receive it in the past.Outcomes research will reveal how much this impacts morbidity and mortality.