The 130th Annual Meeting of APHA

Abstract #40344

Geraldine Oliva, MD MPH¹, L Remy, PhD², and T Clay, MS². (1) Family Health Outcomes Project, University of California, San Francisco, 3333 California Street, Suite 365, San Francisco, CA 94118, 415-476-5283, dyleli@itsa.ucsf.edu, (2) Family Health Outcomes Project, University of California San Francisco, 3333 California Street, Room 365, San Francisco, CA 94118

Between 1983-2000, California hospitals admitted 3.3 million children age 30 days to 14 years. During this period, California instituted major public healthcare initiatives intended to increase insurance coverage and decrease costs. These policies were differentially implemented in California's 61 health jurisdictions. OBJECTIVES: To determine the relationships between geographic differences in indicators of children's access to hospital care and the implementation of these policy changes. METHODS: Hospital discharge files for 1983-2000 were searched to identify California residents aged 30 days to 14 years. Discharge records were summarized within year and merged with annual hospital and population files. RESULTS: After controlling for population growth and the post-1994 healthcare environment the trend in hospital discharges for children age 0 to 4 was not statistically significant. For children age 5 to 14, admissions decreased from 1983 through 1993 and increased post-1994. Admissions for African American and Latino children increased post-1994. Discharge rates varied widely among counties. From 1983-2000, California lost 147 hospitals discharging children and 50 emergency rooms. Four counties had no ER. The greatest decrease was hospitals operated under for-profit and public auspices. Despite the loss of hospitals and ERs, admissions per ER increased steadily from 1 ER/14,000 in 1983 to 1 ER/24,000 in 2000. Maps indicate hospital and ER closures by county and identify where and when county Medicaid managed care was implemented, and changes in county-level discharge rates. CONCLUSIONS: Medicaid and managed care expansions affected the distribution of hospitals and ERs. Infrastructure changes particularly affected poor children and children of color.

Learning Objectives:

• Describe California population-based trends in children's access to hospitals.
• Identify when key managed care and Medicaid initiatives were implemented.
• Summarize impact of these initiatives on access to hospital care for poor children and children of color.

Keywords: Health Care Reform, Children

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.