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The Relationship Between the Patient-Centered Medical Homes, Healthcare Expenditures, and Quality of Care Among Children with Special Health Care Needs

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Abstract

Objectives To examine the association between having a patient-centered medical home (PCMH) and healthcare expenditures and quality of care for children with special health care needs (CSHCN). Methods We conducted a cross-sectional analysis of 8802 CSHCN using the 2008–2012 Medical Expenditure Panel Survey. A PCMH indicator was constructed from survey responses. Inverse probability treatment weighting was applied to balance the cohort. CSHCN’s annual health care expenditures and quality were analyzed using two-part and logistic models, respectively. Results Covariate-adjusted annual total expenditures were similar between CSHCN with and without a PCMH ($4267 vs. $3957, p = 0.285). CSHCN with a PCMH had higher odds of incurring expenditure (OR 1.66, 95% CI 1.22–2.25)—in particular, office-based services and prescriptions (OR 1.46 and 1.36, 95% CI 1.24–1.72 and 1.17–1.58, respectively)—compared to those without a PCMH, without shifting expenditures. When examined in detail, PCMH was associated with lower odds of accessing office-based mental health services (OR 0.80, 95% CI 0.66–0.96), leading to lower expenditures ($106 vs. $137; p = 0.046). PCMH was associated with higher odds of post-operation and immunization visits (OR 1.23 and 1.22, 95% CI 1.05–1.45 and 1.004–1.48, respectively) without changing expenditures. Parents of CSHCN with a PCMH were more likely to report having the best health care quality (OR 2.33, p < 0.001). Conclusions CSHCN who had a PCMH experienced better health care quality and were more likely to access preventive services, with unchanged expenditures. However, they were less likely to use mental health services in office-based settings. As the effects of PCMH varied across services for CSHCN, more research is warranted.

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Notes

  1. Nationwide Report from 2009/10 National Survey of Children with Special Health Care Needs. Retrieved from http://www.childhealthdata.org.

  2. MEPS-HC Sample Design and Collection Process. Retrieved from http://www.meps.ahrq.gov/survey_comp/hc_data_collection.jsp.

  3. Using Appropriate Price Indices for Analyses of Health Care Expenditures or income across multiple years. Retrieved from https://meps.ahrq.gov/about_meps/Price_Index.shtml.

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Funding

Funding was provided by Leonard D. Schaeffer Center for Health Policy and Economics (US) and Medica Research Institute.

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Authors and Affiliations

  1. Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, 635 Downey Way, Suite 210, Los Angeles, CA, 90089-3333, USA

    Chia-Wei Lin

  2. Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, 635 Downey Way, Suite 414A, Los Angeles, CA, 90089-3333, USA

    John A. Romley

  3. Department of Family Medicine and Community Health, University of Minnesota, 420 Delaware St. SE, MMC 381, Minneapolis, MN, 55455, USA

    Caroline Carlin

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  1. Chia-Wei Lin
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  2. John A. Romley
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Correspondence to John A. Romley.

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Lin, CW., Romley, J.A. & Carlin, C. The Relationship Between the Patient-Centered Medical Homes, Healthcare Expenditures, and Quality of Care Among Children with Special Health Care Needs. Matern Child Health J 22, 1751–1760 (2018). https://doi.org/10.1007/s10995-018-2572-4

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