Evaluating the Impact of Parent-Reported Medical Home Status on Children's Health Care Utilization, Expenditures, and Quality

A Difference-In-Differences Analysis with Causal Inference Methods

Published in: Health Services Research, 2016

Posted on RAND.org on July 05, 2016

by Bing Han, Hao Yu, Mark W. Friedberg

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Research Question

  1. How do changes in medical home status affect health care utilization, expenditures, and quality of care for children?

Objective

To evaluate the effects of the parent-reported medical home status on health care utilization, expenditures, and quality for children.

Data Sources

Medical Expenditure Panel Survey (MEPS) during 2004–2012, including a total of 9,153 children who were followed up for 2 years in the survey.

Study Design

We took a causal difference-in-differences approach using inverse probability weighting and doubly robust estimators to study how changes in medical home status over a 2-year period affected children's health care outcomes. Our analysis adjusted for children's sociodemographic, health, and insurance statuses. We conducted sensitivity analyses using alternative statistical methods, different approaches to outliers and missing data, and accounting for possible common-method biases.

Principal Findings

Compared with children whose parents reported having medical homes in both years 1 and 2, those who had medical homes in year 1 but lost them in year 2 had significantly lower parent-reported ratings of health care quality and higher utilization of emergency care. Compared with children whose parents reported having no medical homes in both years, those who did not have medical homes in year 1 but gained them in year 2 had significantly higher ratings of health care quality, but no significant differences in health care expenditures and utilization.

Conclusions

Having a medical home may help improve health care quality for children; losing a medical home may lead to higher utilization of emergency care.

Key Findings

  • Having a medical home may lead to higher perceived quality of care for children.
  • Children who lost medical home status may have more ER visits, compared with children whose status was not interrupted.
  • The reasons for loss are unclear.

Recommendations

  • Policies are needed to help children avoid losing their medical homes.
  • Policies that encourage children to gain medical homes through value-based insurance design or incentives to provide medical home services may be valuable.

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