医疗补助责任医疗组织对儿童获得和利用医疗服务的影响。

IF 3.1 2区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Joanne Constantin PhD, MPH, George L. Wehby PhD, MPH
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引用次数: 0

摘要

研究目的评估医疗补助责任医疗组织(ACO)对儿童获得和利用医疗服务的影响:本研究采用差异模型,对 2018 年至 2021 年的 ACO 州和非 ACO 州进行比较。获取措施包括预防和疾病护理来源、未满足的医疗保健需求以及拥有私人医生或护士等指标。利用措施包括预防和牙科保健、精神保健、专科就诊、急诊就诊和入院:二级、去标识化数据来自 2016-2021 年全国儿童健康调查。样本包括参加公共保险的儿童,根据结果的不同,样本数在 21,452 到 37,177 之间:医疗补助 ACO 的实施与儿童拥有私人医生或护士的可能性增加约 4 个百分点有关,主要集中在 2018 年实施 ACO 的州。医疗补助 ACO 还与专科护理使用率增加和急诊就诊率下降约 5 个百分点有关(后者主要集中在 2020 年实施 ACO 的各州)。与其他儿科结果没有明显或强有力的关联:关于医疗补助 ACO 与儿科就医和使用结果之间的关联,证据不一。对 ACO 实施后较长时期内的效果进行研究非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Effects of Medicaid Accountable Care Organizations on children's access to and utilization of health services

Effects of Medicaid Accountable Care Organizations on children's access to and utilization of health services

Objective

To evaluate the effects of Medicaid Accountable Care Organizations (ACOs) on children's access to and utilization of health services.

Study Setting and Design

This study employs difference-in-differences models comparing ACO and non-ACO states from 2018 through 2021. Access measures are indicators for preventive and sick care sources, unmet healthcare needs, and having a personal doctor or nurse. Utilization measures are preventive and dental care, mental healthcare, specialist visits, emergency department visits, and hospital admissions.

Data Sources and Analytic Sample

Secondary, de-identified data come from the 2016–2021 National Survey of Children's Health. The sample includes children with public insurance and ranges between 21,452 and 37,177 depending on the outcome.

Principal Findings

Medicaid ACO implementation was associated with an increase in children's likelihood of having a personal doctor or nurse by about 4 percentage-points concentrated among states that implemented ACOs in 2018. Medicaid ACOs were also associated with an increase in specialist care use and decline in emergency visits by about 5 percentage-points (the latter being concentrated among states that implemented ACOs in 2020). There were no discernable or robust associations with other pediatric outcomes.

Conclusions

There is mixed evidence on the associations of Medicaid ACOs with pediatric access and utilization outcomes. Examining effects over longer periods post-ACO implementation is important.

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来源期刊
Health Services Research
Health Services Research 医学-卫生保健
CiteScore
4.80
自引率
5.90%
发文量
193
审稿时长
4-8 weeks
期刊介绍: Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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