An Ounce of Prevention
Child Health Politics under Medicaid
This book identifies the flaws in policy formulation and implementation that crippled the EPSDT program.
Medicaid's Early and Periodic Screening, Diagnostic, and Treatment Program (EPSDT) began in 1968 with high hopes of bringing preventive and curative health services to poor children. By 1975, the program was being described as "abominable," and even its advocates conceded that its record had "not been impressive." Although it provided health care for millions of children who would otherwise not have received it, the program was misconceived from the start and poorly implemented thereafter. This book identifies the flaws in policy formulation and implementation that crippled the EPSDT program. It isolates the generic pitfalls of any program that is federally mandated but managed by the separate states, and offers implicit guidelines for the construction of workable future national health programs.
Part I: Formation and Implementation of Child Health Policy Under Medicaid • The Development of EPSDT • Implementation • Incrementalism at Work • Part II: Institutional Constraints • Federal-State Relations • Health and Welfare Ideologies • Bureaucratic Capacity: Case Management Systems (Connecticut, Texas) • Institutional Constraints • Part III: The Technological Constraint: Is There a Consensus? Searching for a Consensus on Standards for Child Health Care • What do PolicyMakers Know and When do They Know It? (The Swine-Flu Fiasco): The Technological Constraint • Conclusion: Politics, Prevention, and Policy