Pediatric outpatient utilization by differing Medicaid payment models in the United States

BMC Health Services Research
Therese CanaresAmanda Montalbano

Abstract

In the United States (US), Medicaid capitated managed care costs are controlled by optimizing patients' healthcare utilization. Adults in capitated plans utilize primary care providers (PCP) more than emergency departments (ED), compared to fee-for-service (FFS). Pediatric data are lacking. We aim to determine the association between US capitated and FFS Medicaid payment models and children's outpatient utilization. This retrospective cohort compared outpatient utilization between two payment models of US Medicaid enrollees aged 1-18 years using Truven's 2014 Marketscan Medicaid database. Children enrolled > 11 months were included, and were excluded for eligibility due to disability/complex chronic condition, lack of outpatient utilization, or provider capitation penetration rate < 5% or > 95%. Negative binomial and logistic regression assessed relationships between payment model and number of visits or odds of utilization, respectively. Of 711,008 children, 66,980(9.4%) had FFS and 644,028(90.6%) had capitated plans. Children in capitated plans had greater odds of visits to urgent care, PCP-acute, and PCP-well-child care (aOR 1.21[95%CI 1.15-1.26]; aOR 2.07[95%CI 2.03-2.13]; aOR 1.86 [95%CI 1.82-1.91], respectively), and had ...Continue Reading

References

Sep 10, 2003·Archives of Pediatrics & Adolescent Medicine·Arthur ElsterMissy Fleming
Sep 22, 2005·Health Services Research·Laurence C Baker, Christopher Afendulis
Oct 6, 2005·The Milbank Quarterly·Barbara StarfieldJames Macinko
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Citations

Feb 20, 2021·Academic Pediatrics·Jennifer D KusmaMatthew M Davis
Jan 5, 2022·Current Opinion in Pediatrics·Daniella GrataleKatie Boyer

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