Paying for Pediatric Home Health Care: How Families of Children With Medical Complexity Navigate Gaps in Coverage.
Journal
Family & community health
ISSN: 1550-5057
Titre abrégé: Fam Community Health
Pays: United States
ID NLM: 7809641
Informations de publication
Date de publication:
Historique:
pubmed:
1
5
2021
medline:
7
10
2021
entrez:
30
4
2021
Statut:
ppublish
Résumé
Limited private and public financing of home health care for children with medical complexity can have harmful and costly consequences. Little is known of how parents and professionals in the United States navigate coverage for these services or how payer restrictions are shaping service quality. Qualitative interviews were conducted with families and professionals (eg, prescribers, providers, administrators of pediatric home health care [PHHC]) caring for children with medical complexity. Interview transcripts were analyzed using inductive thematic analysis. In total, 47 families and 45 professionals from across 31 states and the District of Columbia had experiences with the full range of PHHC services. Participants detailed the need to patch together multiple insurances and payment programs to cover a child's home health needs. They described nontransparent eligibility determinations that do not reflect the diagnostic uncertainty and static functional status that is common for many children. Coverage denials are common, leaving gaps in care that can potentiate downstream cost escalation. Evidence-based health care reform must ensure that children get the PHHC needed to maintain function and reduce the need for hospital-based services. Recommendations are offered to improve PHHC financing and care for the most medically vulnerable children and their families.
Identifiants
pubmed: 33927166
doi: 10.1097/FCH.0000000000000300
pii: 00003727-202107000-00009
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
184-193Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare that they have no conflict of interest.
Références
Simon TD, Berry J, Feudtner C, et al. Children with complex chronic conditions in inpatient hospital settings in the United States. Pediatrics. 2010;126(4):647–655.
Cohen E, Kuo DZ, Agrawal R, et al. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics. 2011;127(3):529–538.
Gay JC, Thurm CW, Hall M, et al. Home health nursing care and hospital use for medically complex children. Pediatrics. 2016;138(5):e20160530.
Simpser E, Hudak ML. Financing of pediatric home health care. Pediatrics. 2017;139(3):e20164202.
Berry JG, Hall M, Neff J, et al. Children with medical complexity and Medicaid: spending and cost savings. Health Aff. 2014;33(12):2199–2206.
Foster CC, Agrawal RK, Davis MM. Home health care for children with medical complexity: workforce gaps, policy, and future directions. Health Aff. 2019;38(6):987–993.
Musumeci M, Chidambaram P. Medicaid's Role for Children With Special Health Care Needs: A Look at Eligibility, Services, and Spending. Oakland, CA: Henry J. Kaiser Family Foundation; 2019.
Perkins J, Agrawal R. Protecting rights of children with medical complexity in an era of spending reduction. Pediatrics. 2018;141(suppl 3):S242–S249.
Sobotka SA, Gaur DS, Goodman DM, Agrawal RK, Berry JG, Graham RJ. Pediatric patients with home mechanical ventilation: the health services landscape. Pediatr Pulmonol. 2019;54(1):40–46.
Nageswaran S, Golden SL. Improving the quality of home health care for children with medical complexity. Acad Pediatr. 2017;17(6):665–671.
Maynard R, Christensen E, Cady R, et al. Home health care availability and discharge delays in children with medical complexity. Pediatrics. 2019;143(1):e20181951.
Institute of Medicine. Coverage Matters: Insurance and Health Care. Washington, DC: The National Academies Press; 2001. doi:10.17226/10188.
Health Resources and Services Administration. Office of Regional Operations. https://www.hrsa.gov/about/organization/bureaus/oro/index.html. Accessed June 22, 2019.
Fratantoni K, Raisanen JC, Boss RD, et al. The pediatric home health care process: perspectives of prescribers, providers, and recipients. Pediatrics. 2019;144(3):e20190897.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Dedoose. Version 8.0.25. Los Angeles, CA: SocioCultural Research Consultants LLC; 2018. www.dedoose.com. Accessed January 5, 2021.
Markus AR, West KD. Defining and determining medical necessity in Medicaid managed care. Pediatrics. 2014;134(3):516–522.
Coleman CL. Not just along for the ride: families are the engine that drives pediatric home health care. Health Affairs Blog. Posted 2019. https://www.healthaffairs.org/do/10.1377/hblog20190415.172668/full/. Accessed January 5, 2021.
Musumeci M, Chidambaram P. How Do Medicaid/CHIP Children With Special Health Care Needs Differ From Those With Private Insurance? Oakland, CA: Henry J. Kaiser Family Foundation; 2019.
Gengler AM. “I want you to save my kid!” illness management strategies, access, and inequality at an elite university research hospital. J Health Soc Behav. 2014;55(3):342–359.
Gage-Bouchard EA. Social support, flexible resources, and health care navigation. Soc Sci Med. 2017;190:111–118.
Shim JK. Cultural health capital: a theoretical approach to understanding health care interactions and the dynamics of unequal treatment. J Health Soc Behav. 2010;51(1):1–15.