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Value for the Money Spent? Exploring the Relationship Between Expenditures, Insurance Adequacy, and Access to Care for Publicly Insured Children

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Abstract

This study examines the relationship between total state Medicaid spending per child and measures of insurance adequacy and access to care for publicly insured children. Using the 2007 National Survey of Children’s Health, seven measures of insurance adequacy and health care access were examined for publicly insured children (n = 19,715). Aggregate state-level measures were constructed, adjusting for differences in demographic, health status, and household characteristics. Per member per month (PMPM) state Medicaid spending on children ages 0–17 was calculated from capitated, fee-for-service, and administrative expenses. Adjusted measures were compared with PMPM state Medicaid spending in scatter plots, and multilevel logistic regression models tested how well state-level expenditures predicted individual adequacy and access measures. Medicaid spending PMPM was a significant predictor of both insurance adequacy and receipt of mental health services. An increase of $50 PMPM was associated with a 6–7 % increase in the likelihood that insurance would always cover needed services and allow access to providers (p = 0.04) and a 19 % increase in the likelihood of receiving mental health services (p < 0.01). For the remaining four measures, PMPM was a consistent (though not statistically significant) positive predictor. States with higher total spending per child appear to assure better access to care for Medicaid children. The policies or incentives used by the few states that get the greatest value—lower-than-median spending and higher-than-median adequacy and access—should be examined for potential best practices that other states could adapt to improve value for their Medicaid spending.

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Notes

  1. Beginning FY 1998, capitated premiums for Medicaid eligibles enrolled in managed care plans were included in the category “other,” so the increase in “other” types of payment from 58.7 % in 1998 to 68.4 % in 2007 could include some services besides capitated payments.

  2. Comprehensive managed care enrollment is authors’ calculation using data reported in [24]. See “Methods”.

  3. We excluded Maine from the analysis, as only prescription drug expenditures were reported in 2006.

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Authors and Affiliations

  1. Mathematica Policy Research, Inc., 1100 1st Street, NE, 12th Floor, Washington, DC, 20002-4221, USA

    Margaret S. Colby & Debra J. Lipson

  2. School of Social Work, Columbia University, New York, NY, USA

    Sarah R. Turchin

Authors
  1. Margaret S. Colby
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  2. Debra J. Lipson
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  3. Sarah R. Turchin
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Correspondence to Margaret S. Colby.

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Colby, M.S., Lipson, D.J. & Turchin, S.R. Value for the Money Spent? Exploring the Relationship Between Expenditures, Insurance Adequacy, and Access to Care for Publicly Insured Children. Matern Child Health J 16 (Suppl 1), 51–60 (2012). https://doi.org/10.1007/s10995-012-0994-y

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