Published online October 2, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. e1187-e1194 (doi:10.1542/10.1542/peds.2005-3018)

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ARTICLE

Cost of Outpatient Medical Care for Children and Youth With Special Health Care Needs: Investigating the Impact of the Medical Home

Peter C. Damiano, DDS, MPH^a,b, Elizabeth T. Momany, PhD^a, Margaret C. Tyler, MA, MSW^a, Andrew J. Penziner, MD^c and Jeffrey G. Lobas, MD, EdD, MPA^c,d

^a Health Policy Research Program, Public Policy Center
^b Departments of Preventive and Community Dentistry
^d Pediatrics
^c Child Health Specialty Clinics, University of Iowa, Iowa City, Iowa

OBJECTIVE. Our goal was to evaluate the impact of having a medical home on the outpatient medical costs of children and youth with special health care needs.

DESIGN. Data from 2 sources were matched at the individual level: (1) the 2002 Iowa Consumer Assessment of Health Plans Study survey of Medicaid enrollees and (2) Iowa Medicaid administrative claims, encounter, and enrollment files.

PARTICIPANTS. The subjects were 1140 children aged 6 months to 12 years for whom both sources of data were available.

MAIN OUTCOME MEASURE(S). Outcomes measures included medical homeness, as developed by a scale of items in the Consumer Assessment of Health Plans Study survey, and outpatient costs, as determined from Medicaid administrative data.

RESULTS. From the regression models, we found that (1) for all Medicaid-enrolled children, outpatient costs were significantly higher for female children and children and youth with special health care needs, (2) for children and youth without special health care needs, costs were significantly higher for female children, those with a personal doctor or nurse, and those with more of a medical home, and (3) for children and youth with special health care needs, costs were significantly higher for those in a lower health state, for those in health maintenance organization 2, and for older children.

CONCLUSIONS. Although the degree of medical homeness was not related to outpatient costs for children and youth with special health care needs, medical homeness may affect inpatient costs more than outpatient costs for children and youth with special health care needs and should be investigated further.

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Key Words: medical home • CAHPS • CYSHCN • outpatient costs

Abbreviations: AAP—American Academy of Pediatrics • CYSHCN—children and youth with special health care needs • CAHPS—Consumer Assessment of Health Plans Study • TANF—Temporary Assistance for Needy Families program • FPL—federal poverty level • CAHMI—Children and Adolescent Health Measurement Initiative • HMO—health maintenance organization

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Accepted May 24, 2006.

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