title: Gastrointestinal symptoms and use of medical care associated with child day care and health care plan among preschool children.
abstract: OBJECTIVE
  This study examined whether out-of-home day care increases the risk of gastrointestinal symptoms for children <6 years of age and whether there is an association between gastrointestinal symptoms and medical care utilization.
  
  
  METHODS
  The study population comprised members of 2 health plans residing in 2 South Carolina counties: 417 families from an health maintenance organization (HMO) plan; and 643 families from a Medicaid plan. Participants were followed for 18 months by either bimonthly telephone interviews or personal interviews. The survey/interview collected familial, personal, day-care and disease-related information and medical care utilization. The analyses controlled for both family characteristics and the type of health care plan.
  
  
  RESULTS
  Children attending out-of-home day care had higher incidence rates for most gastrointestinal symptoms studied than did children staying at home (2.51 vs. 1.61 episodes of mild gastrointestinal symptoms and 1.63 vs. 1.08 episodes of moderate gastrointestinal symptoms for the HMO group; 1.72 vs. 1.28 episodes of moderate gastrointestinal symptoms for the Medicaid group). Nearly one-fourth of the annual physician visits by children younger than 6 years were attributed to gastrointestinal symptoms, and more than one-fourth of the children with gastrointestinal symptoms were prescribed antibiotics. When displaying gastrointestinal symptoms, children in the Medicaid group were significantly more likely to visit a doctor and receive antibiotics than those in the HMO group.
  
  
  CONCLUSIONS
  Although the type of health plan has negligible influence on the frequency of reported gastrointestinal symptoms, it exerts a strong influence on medical care utilization.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins School of Public Health and Hygiene, Baltimore, MD 21205-1996, USA. lshi@jhsph.edu
authors.forename: L
authors.initials: L
authors.lastname: Shi
authors.forename: Y
authors.initials: Y
authors.lastname: Huang
authors.forename: K
authors.initials: K
authors.lastname: Kelly
authors.forename: M
authors.initials: M
authors.lastname: Zhao
authors.forename: S L
authors.initials: SL
authors.lastname: Solomon
mesh_terms: D002654:Child Care / Q000379:methods; D002656:Child Day Care Centers; D002675:Child, Preschool; D005190:Family; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006279:Health Maintenance Organizations; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008484:Medicaid; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology; D014481:United States