Medical home access and health care use and expenditures among children with special health care needs. 2012

Melissa A Romaire, and Janice F Bell, and David C Grossman
Department of Health Services, School of Public Health, University of Washington, 1959 NE Pacific St, PO Box 357660, Seattle, WA 98195-7660, USA. mromaire@u.washington.edu

OBJECTIVE To test associations between having a medical home and health services use and expenditures among US children with special health care needs (CSHCN). METHODS Cross-sectional analysis. METHODS The 2003-2008 Medical Expenditure Panel Surveys. METHODS A total of 9816 CSHCN up to 17 years, including 1056 with a functional or sensory limitation and 8760 without a limitation. METHODS Parent or caregiver report of CSHCN having a medical home. METHODS We examined CSHCN's annual use of outpatient, inpatient, emergency department, and dental visits, and annual outpatient, inpatient, emergency department, prescription medication, dental, and other health care expenditures. RESULTS CSHCN with a medical home had 14% more dental visits compared with CSHCN without a medical home (incidence rate ratio [IRR], 1.14; 95% CI, 1.03-1.25); this finding is significant for CSHCN without limitations but not for those with limitations. The medical home was associated with greater odds of incurring total, outpatient, prescription medication, and dental expenditures (odds ratio range, 1.25-1.92). Among CSHCN with a limitation, children with a medical home had lower annual inpatient expenditures compared with those without a medical home (mean, -$968; 95% CI, -$121 to -$1928), and among CSHCN without a limitation, children with a medical home had higher annual prescription medication expenditures compared with those without a medical home (mean, $87; 95% CI, $22-$153). CONCLUSIONS There were few differences in annual health services use and expenditures between CSHCN with and without a medical home. However, the medical home may be associated with lower inpatient expenditures and higher prescription medication expenditures within subgroups of CSHCN.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D008297 Male Males
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002662 Child Health Services Organized services to provide health care for children. Infant Health Services,Child Services, Health,Health Services, Child,Health Services, Infant,Infant Services, Health,Services, Child Health,Services, Infant Health,Child Health Service,Health Service, Child,Health Service, Infant,Infant Health Service,Service, Child Health,Service, Infant Health
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D003430 Cross-Sectional Studies Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time. Disease Frequency Surveys,Prevalence Studies,Analysis, Cross-Sectional,Cross Sectional Analysis,Cross-Sectional Survey,Surveys, Disease Frequency,Analyses, Cross Sectional,Analyses, Cross-Sectional,Analysis, Cross Sectional,Cross Sectional Analyses,Cross Sectional Studies,Cross Sectional Survey,Cross-Sectional Analyses,Cross-Sectional Analysis,Cross-Sectional Study,Cross-Sectional Surveys,Disease Frequency Survey,Prevalence Study,Studies, Cross-Sectional,Studies, Prevalence,Study, Cross-Sectional,Study, Prevalence,Survey, Cross-Sectional,Survey, Disease Frequency,Surveys, Cross-Sectional
D005102 Health Expenditures The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers. Expenditure,Expenditures, Health,Health Expenditure,Out Of Pocket Expenditure,Out-of-Pocket Cost,Out-of-Pocket Expense,Out-of-Pocket Payment,Expenditures,Expenditures, Direct,Expenditures, Indirect,Expenditures, Out-of-Pocket,Out-of Pocket Expenditures,Out-of-Pocket Costs,Out-of-Pocket Expenses,Out-of-Pocket Payments,Out-of-Pocket Spending,Cost, Out-of-Pocket,Costs, Out-of-Pocket,Direct Expenditure,Direct Expenditures,Expenditure, Direct,Expenditure, Health,Expenditure, Indirect,Expenditure, Out-of Pocket,Expenditure, Out-of-Pocket,Expenditures, Out of Pocket,Expenditures, Out-of Pocket,Expense, Out-of-Pocket,Expenses, Out-of-Pocket,Indirect Expenditure,Indirect Expenditures,Out of Pocket Cost,Out of Pocket Costs,Out of Pocket Expenditures,Out of Pocket Expense,Out of Pocket Expenses,Out of Pocket Payment,Out of Pocket Payments,Out of Pocket Spending,Out-of Pocket Expenditure,Out-of-Pocket Expenditure,Out-of-Pocket Expenditures,Payment, Out-of-Pocket,Payments, Out-of-Pocket,Spending, Out-of-Pocket
D005260 Female Females
D006297 Health Services Accessibility The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others. Access To Care, Health,Access to Care,Access to Contraception,Access to Health Care,Access to Health Services,Access to Medications,Access to Medicines,Access to Therapy,Access to Treatment,Accessibility of Health Services,Availability of Health Services,Contraception Access,Contraceptive Access,Medication Access,Accessibility, Health Services,Contraceptive Availability,Health Services Geographic Accessibility,Program Accessibility,Access to Cares,Access to Contraceptions,Access to Medication,Access to Medicine,Access to Therapies,Access to Treatments,Access, Contraception,Access, Contraceptive,Access, Medication,Accessibilities, Health Services,Accessibility, Program,Availability, Contraceptive,Care, Access to,Cares, Access to,Contraception, Access to,Contraceptive Accesses,Health Services Availability,Medication Accesses,Medication, Access to,Medicine, Access to,Medicines, Access to,Therapy, Access to,Treatment, Access to

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