PEDIATRICS Vol. 108 No. 1 July 2001, pp. 103-110
Effects of Medicaid Managed Care on Health Care Use: Infant Emergency Department and Ambulatory Services
Received Jun 15, 2000; accepted Oct 10, 2000.
, and
From the Divisions of * Emergency Medicine and Objective. Many urban children rely
on emergency departments (ED) for ambulatory care. The objective of
this study was to determine whether enrollment in Medicaid managed care
(MMC) alters ED or other ambulatory care compared with fee-for-service
Medicaid (FFSM).
Methods. A prospective cohort study of infants born
between May 1994 and April 1995 with a 6-month follow-up period was
conducted in an urban, teaching hospital and surrounding ambulatory
settings. A consecutive sample of 644 infants enrolled in MMC or FFSM
was studied; 92% of eligible patients were enrolled, and 94%
completed follow-up. The main outcome measures were 1) proportion of
patients in each group visiting an ED, primary care practitioner (PCP), or specialist; 2) mean number of visits per group; and 3) ED reliance (EDR) defined as the proportion of all ambulatory visits occurring in
an ED.
Results. Fifty-six percent of MMC and 54% of FFSM
patients visited an ED (relative risk: 1.03; 95% confidence interval
[CI]: 0.83, 1.27). More MMC patients had a sick visit to their PCP
(relative risk: 1.34; 95% CI: 1.03, 1.74); no difference in proportion
with well-child or specialty visits was found. Although the mean number of total ambulatory, ED, and specialty visits was the same, MMC patients had fewer well-child and more sick visits to the PCP than FFSM
patients (P = .01). EDR was 21% for both groups
(P = .95). After adjustment for other factors in
multivariate analysis, insurance status remained unassociated with EDR
(adjusted odds ratio [OR]: 0.91; 95% CI: 0.56, 1.69). Factors
associated with EDR included United States-born mother (OR: 5.34; 95%
CI: 1.61, 17.68) and use of a hospital-based primary care physician
(OR: 2.00; 95% CI: 1.34, 2.98). Variables that characterized infants who were less likely to be ED reliant included adequate maternal prenatal care (OR: 0.52; 95% CI: 0.34, 0.78) and having a mother who
completed high school (OR: 0.67; 95% CI: 0.45, 0.99).
Conclusions. Enrollment in MMC did not alter ED usage
patterns when compared with FFSM. Some variation in use of other
ambulatory services was detected.
Adolescent
Medicine, The Children's Hospital of Philadelphia, and § Department of
Biostatistics and Epidemiology, University of Pennsylvania School of
Medicine, Philadelphia, Pennsylvania; and Department of Pediatrics,
Yale University School of Medicine, New Haven, CT.
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