Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 77-83 (doi:10.1542/10.1542/peds.2007-2985)
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ARTICLE

An Investment in Health: Anticipating the Cost of a Usual Source of Care for Children

Sarah A. Birken, MSPH and Michelle L. Mayer, PhD{dagger}

Department of Health Policy and Administration, University of North Carolina, Chapel Hill, North Carolina

OBJECTIVES. Among adults, having a usual source of care has been associated with lower health care expenditures primarily through decreased emergency department and inpatient expenditures. The extent of this effect among children is unknown. We hypothesized that children with a usual source of care would have greater odds of having any outpatient expenditures, lower odds of emergency department and inpatient expenditures, and lower expenditures overall.

PATIENTS AND METHODS. Using a 2-part model, we studied expenditures among children ≤17 years of age in the 2004 Medical Expenditure Panel Survey (N = 8810). Logistic regression was used to assess the relationship between having a usual source of care and the odds of having any outpatient, emergency department, and inpatient expenditures, and ordinary least-squares regression was used to compare the amount of total, outpatient, emergency department, and inpatient expenditures among children with and without a usual source of care, controlling for confounders.

RESULTS. The odds of having any expenditures overall and any outpatient expenditures were 2.42 and 2.91 times higher among children with a usual source of care than among those without a usual source of care. The odds of having any emergency department or inpatient visits did not differ between groups. Having a usual source of care was associated with higher total expenditures and lower inpatient expenditures.

CONCLUSIONS. Having a usual source of care is associated with increased odds of having any expenditures overall and any outpatient expenditures, higher total expenditures, and lower inpatient expenditures. Because emergency department and inpatient visits are less common among children than among adults, reductions in receipt of such care do not offset the associated increase in total expenditures and may not be appropriate indicators of the benefit of having a usual source of care among children. Intermediate indicators such as receipt of age-appropriate preventive services should be assessed.

Key Words: usual source of care • access to care • cost analysis • children and adolescents

Abbreviations: USC—usual source of care • ED—emergency department • MEPS—Medical Expenditure Panel Survey

Accepted Mar 25, 2008.


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