Reviews the changes managed health care has brought to the delivery and use of medical services and recommends specific steps that will make the existing system more responsive to the needs of children. Systemwide health care reforms must give children stable medical care that emphasizes preventive health and developmental services. (SLD)

Lays the foundation for other articles in this special issue by providing an overview of managed health care as it now operates. Children are increasingly being enrolled in such plans even though there is little information about the effects of managed health care on this population. (SLD)

Presents the perspectives of a parent and a pediatrician on managed health care for children. The parent's experience in obtaining care for her disabled child demonstrates many pitfalls in the system. The pediatrician stresses that advocacy for child health should promote child health through managed care, rather than protect children from managed…

Reviews what is known about the effect of managed care on access to health services, as well as utilization of hospital care, emergency department visits, primary care services, and specialty pediatric services. The effect of managed care appears dependent on several factors and, thus, is likely to vary according to the population served. (SLD)

Information available so far indicates that children in managed care arrangements are less likely to be seen by pediatric specialists and that families and providers are less satisfied under managed care. In spite of these drawbacks, the managed care approach, modified appropriately, offers new opportunities to provide high-quality medical care…

Presents recommendations for contracting elements that should be adopted by state Medicaid agencies and approaches that should be taken by managed care practices interested in providing high-quality care for children with special needs. These recommendations are based on interviews with administrators from 29 states and 22 plans. (SLD)

Summarizes efforts by state governments to regulate managed care and examines the various actions that states have initiated to credential managed care plans that desire to provide care for Medicaid beneficiaries. In the long run, organizations other than state regulatory agencies may be better equipped to regulate managed care. (SLD)

Preliminary results from the Health Care Reform Tracking Project's baseline survey and site visits to 10 states show that managed care has generally improved access to health care for children, but it has made it more difficult for youths with serious emotional disorders, and uninsured children, to obtain care. (SLD)

Reviews the basic decisions states must make when implementing State Children's Health Insurance Program (CHIP) programs and reports on the decisions states participating in this federal program have made, as reflected in the plans they submitted to the Health Care Financing Administration. Sources of information about the program are included.…

Recently states have increasingly turned to managed care arrangements to finance and deliver health services to Medicaid beneficiaries. As this trend continues, states should carefully monitor changes in program costs and quality and implications for delivery of pediatric services and health outcomes for children. (SLD)

Identifies the following basic issues involved in planning and implementing school-linked services: (1) planning; (2) targeting; (3) governance; (4) information systems; and (5) staffing. Effective planning requires a policy-minded team of equals from various agencies. Strategies that community teams can use to address each issue are discussed.…

The staff of the Center for the Future of Children analyzes policies to make the U.S. health care system more responsive to the needs of children and pregnant women focusing on (1) efficiency; (2) access; and (3) affordability. Recommendations are made in each of these areas. (SLD)

The current tripartite system of human services delivery (education, health, and social services) is unable to deal with children with multiple problems in an effective, coordinated way due to fragmentation, specialization, and complexity. Reorganizing the current system by linking or integrating services could provide many advantages, as…

Describes goals, beneficiaries, offerings, locations, and providers of six current school-linked service efforts. Identifies several integrating elements needed for systemic reforms to make school-linked services produce more successful outcomes for children and families. Programmatic initiatives must complement deep-reaching changes in ways…

Reviews types of evaluation that may be applied to school-linked services; and discusses the needs for a range of evaluative strategies for program providers, policymakers, and funders. For some programs evaluation will be primarily descriptive, whereas for others a carefully designed outcome evaluation will be possible. (SLD)