Health care use and expenditures associated with access to the medical home for children and youth

Melissa A. Romaire, Janice F Bell, David C. Grossman

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND: The pediatric medical home is an approach to the delivery of family-centered health care. Policy-makers and payers are interested in potential changes to health care utilization and expenditures under this model. OBJECTIVE: To test associations between having a medical home and health service use and expenditures among US children and youth. RESEARCH DESIGN: Observational cross-sectional study. SUBJECTS: A total of 26,221 children aged 0 to 17 years surveyed in the 2005 to 2007 Medical Expenditure Panel Surveys. MEASURES: Parent report of a child's access to a medical home was developed from multiple survey items in the Medical Expenditure Panel Surveys. Negative binomial regression examined the association between the medical home and parent-reported counts of annual outpatient, inpatient, emergency department, and dental visits. Two-part models examined associations between the medical home and parent-reported annual total, outpatient, inpatient, emergency department, and other health care expenditures. Models accounted for potential self-selection into a medical home using propensity scores. RESULTS: Children with a medical home had a greater incidence of preventive visits [incidence rate ratio (IRR)=1.11; (95% confidence intervals (CI), 1.03-1.20)] and dental visits [IRR=1.09 (95% CI, 1.02-1.17)] and a lower incidence of emergency department visits [IRR=0.87 (95% CI, 0.79-0.97)] compared with children without a medical home. Children with a medical home also had greater odds of incurring total, outpatient, prescription medication, and dental expenditures, OR's ranging from 1.09 to 1.38. Despite greater odds of incurring certain expenditures, expenditures were no different for children with and without a medical home. CONCLUSIONS: The medical home is associated with several domains of health service use, yet there is no evidence for its association with health care expenditures for children and youth.

Original languageEnglish (US)
Pages (from-to)262-269
Number of pages8
JournalMedical Care
Volume50
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Patient-Centered Care
Health Expenditures
Delivery of Health Care
Incidence
Hospital Emergency Service
Tooth
Outpatients
Confidence Intervals
Health Services
Inpatients
Patient Acceptance of Health Care
Propensity Score
Family Health
Administrative Personnel
Prescriptions
Cross-Sectional Studies
Pediatrics

Keywords

  • children
  • health expenditures
  • health services
  • medical home
  • patient-centered care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Health care use and expenditures associated with access to the medical home for children and youth. / Romaire, Melissa A.; Bell, Janice F; Grossman, David C.

In: Medical Care, Vol. 50, No. 3, 03.2012, p. 262-269.

Research output: Contribution to journalArticle

Romaire, Melissa A. ; Bell, Janice F ; Grossman, David C. / Health care use and expenditures associated with access to the medical home for children and youth. In: Medical Care. 2012 ; Vol. 50, No. 3. pp. 262-269.
@article{c21a035b8c1742b1b00d4612b7933d9f,
title = "Health care use and expenditures associated with access to the medical home for children and youth",
abstract = "BACKGROUND: The pediatric medical home is an approach to the delivery of family-centered health care. Policy-makers and payers are interested in potential changes to health care utilization and expenditures under this model. OBJECTIVE: To test associations between having a medical home and health service use and expenditures among US children and youth. RESEARCH DESIGN: Observational cross-sectional study. SUBJECTS: A total of 26,221 children aged 0 to 17 years surveyed in the 2005 to 2007 Medical Expenditure Panel Surveys. MEASURES: Parent report of a child's access to a medical home was developed from multiple survey items in the Medical Expenditure Panel Surveys. Negative binomial regression examined the association between the medical home and parent-reported counts of annual outpatient, inpatient, emergency department, and dental visits. Two-part models examined associations between the medical home and parent-reported annual total, outpatient, inpatient, emergency department, and other health care expenditures. Models accounted for potential self-selection into a medical home using propensity scores. RESULTS: Children with a medical home had a greater incidence of preventive visits [incidence rate ratio (IRR)=1.11; (95{\%} confidence intervals (CI), 1.03-1.20)] and dental visits [IRR=1.09 (95{\%} CI, 1.02-1.17)] and a lower incidence of emergency department visits [IRR=0.87 (95{\%} CI, 0.79-0.97)] compared with children without a medical home. Children with a medical home also had greater odds of incurring total, outpatient, prescription medication, and dental expenditures, OR's ranging from 1.09 to 1.38. Despite greater odds of incurring certain expenditures, expenditures were no different for children with and without a medical home. CONCLUSIONS: The medical home is associated with several domains of health service use, yet there is no evidence for its association with health care expenditures for children and youth.",
keywords = "children, health expenditures, health services, medical home, patient-centered care",
author = "Romaire, {Melissa A.} and Bell, {Janice F} and Grossman, {David C.}",
year = "2012",
month = "3",
doi = "10.1097/MLR.0b013e318244d345",
language = "English (US)",
volume = "50",
pages = "262--269",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Health care use and expenditures associated with access to the medical home for children and youth

AU - Romaire, Melissa A.

AU - Bell, Janice F

AU - Grossman, David C.

PY - 2012/3

Y1 - 2012/3

N2 - BACKGROUND: The pediatric medical home is an approach to the delivery of family-centered health care. Policy-makers and payers are interested in potential changes to health care utilization and expenditures under this model. OBJECTIVE: To test associations between having a medical home and health service use and expenditures among US children and youth. RESEARCH DESIGN: Observational cross-sectional study. SUBJECTS: A total of 26,221 children aged 0 to 17 years surveyed in the 2005 to 2007 Medical Expenditure Panel Surveys. MEASURES: Parent report of a child's access to a medical home was developed from multiple survey items in the Medical Expenditure Panel Surveys. Negative binomial regression examined the association between the medical home and parent-reported counts of annual outpatient, inpatient, emergency department, and dental visits. Two-part models examined associations between the medical home and parent-reported annual total, outpatient, inpatient, emergency department, and other health care expenditures. Models accounted for potential self-selection into a medical home using propensity scores. RESULTS: Children with a medical home had a greater incidence of preventive visits [incidence rate ratio (IRR)=1.11; (95% confidence intervals (CI), 1.03-1.20)] and dental visits [IRR=1.09 (95% CI, 1.02-1.17)] and a lower incidence of emergency department visits [IRR=0.87 (95% CI, 0.79-0.97)] compared with children without a medical home. Children with a medical home also had greater odds of incurring total, outpatient, prescription medication, and dental expenditures, OR's ranging from 1.09 to 1.38. Despite greater odds of incurring certain expenditures, expenditures were no different for children with and without a medical home. CONCLUSIONS: The medical home is associated with several domains of health service use, yet there is no evidence for its association with health care expenditures for children and youth.

AB - BACKGROUND: The pediatric medical home is an approach to the delivery of family-centered health care. Policy-makers and payers are interested in potential changes to health care utilization and expenditures under this model. OBJECTIVE: To test associations between having a medical home and health service use and expenditures among US children and youth. RESEARCH DESIGN: Observational cross-sectional study. SUBJECTS: A total of 26,221 children aged 0 to 17 years surveyed in the 2005 to 2007 Medical Expenditure Panel Surveys. MEASURES: Parent report of a child's access to a medical home was developed from multiple survey items in the Medical Expenditure Panel Surveys. Negative binomial regression examined the association between the medical home and parent-reported counts of annual outpatient, inpatient, emergency department, and dental visits. Two-part models examined associations between the medical home and parent-reported annual total, outpatient, inpatient, emergency department, and other health care expenditures. Models accounted for potential self-selection into a medical home using propensity scores. RESULTS: Children with a medical home had a greater incidence of preventive visits [incidence rate ratio (IRR)=1.11; (95% confidence intervals (CI), 1.03-1.20)] and dental visits [IRR=1.09 (95% CI, 1.02-1.17)] and a lower incidence of emergency department visits [IRR=0.87 (95% CI, 0.79-0.97)] compared with children without a medical home. Children with a medical home also had greater odds of incurring total, outpatient, prescription medication, and dental expenditures, OR's ranging from 1.09 to 1.38. Despite greater odds of incurring certain expenditures, expenditures were no different for children with and without a medical home. CONCLUSIONS: The medical home is associated with several domains of health service use, yet there is no evidence for its association with health care expenditures for children and youth.

KW - children

KW - health expenditures

KW - health services

KW - medical home

KW - patient-centered care

UR - http://www.scopus.com/inward/record.url?scp=84857657597&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857657597&partnerID=8YFLogxK

U2 - 10.1097/MLR.0b013e318244d345

DO - 10.1097/MLR.0b013e318244d345

M3 - Article

C2 - 22228246

AN - SCOPUS:84857657597

VL - 50

SP - 262

EP - 269

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 3

ER -