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

摘要

Objective: To test associations between having a medical home and health services use and expenditures among US children with special health care needs (CSHCN). Design: Cross-sectional analysis. Setting: The 2003-2008 Medical Expenditure Panel Surveys. Participants: A total of 9816 CSHCN up to 17 years, including 1056 with a functional or sensory limitation and 8760 without a limitation. Main Exposure: Parent or caregiver report of CSHCN having a medical home. Main Outcome Measures: 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.