Insurance, the Presence of a Medical Home, and the Benefits of Primary Care for Children

Insurance, the Presence of a Medical Home, and the Benefits of Primary Care for Children. Barbara Starfield, MD, MPH November 2002. What increases the likelihood of a medical home?. Starfield 09/02. 100 90 80 70 60 50 40 30 20 10 0. Least vulnerable*. Somewhat vulnerable.
of 22
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Insurance, the Presence of a Medical Home, and the Benefits of Primary Care for ChildrenBarbara Starfield, MD, MPHNovember 2002What increases the likelihood of a medical home?Starfield 09/021009080706050403020100Least vulnerable*Somewhat vulnerableMost vulnerable*Predicted Probability of Having a Usual Source of Care among High-Income Insured, Low-Income Insured, and Uninsured Adults, by State Safety-Net VulnerabilityHigh-income insured*High income insured significantly different from low income insured at the 5% level.Low-income insuredLow-income uninsuredSource: Holahan & Spillman, 2002.Access to Care of Uninsured PersonsPercent of uninsured with a usual source of careAll persons under age 65631-187519-245525-345435-546155-596860-6471Source: Cunningham, 1998.Starfield 10/02Odds Ratios for Factors Associated with Not Usinga Regular Source of Care, US Children, 1991Gap in health insurance 1-6 months 1.5³7 months 1.7Father not employed 1.5No father in home 1.8Family moved 1.7Perceived barrier to care 2.4Child with chronic condition 1.9not significant: parental education, ethnicity, marital status, maternal age, site of usual care, type of health insuranceSource: Kogan et al., 1995.Odds Ratios (Adjusted) for Accessand Use for Uninsured as Comparedwith Insured Children, 1993-4No regular source of care 6.1Unable to get needed medical care 5.8No after-hours medical care 1.6Not satisfied with care 1.4Not seen a doctor in a year 2.1Adjusted for various sociodemographic and health characteristicsSource: Newacheck et al., 1998.Starfield 1998Significant Predictors of PrimaryCare, Inner City Latino Children(Los Angeles), 1992Continuity of well and sick care Continuous Medicaid*1.5 Uninsured*0.4 Source of well child care** HMO20.7 Public clinic0.3 Child health status1.6Starfield 09/02Insurance and HospitalizationsIncreased eligibility for Medicaid significantly reduced rates of hospitalization for ambulatory care sensitive conditions (ACSC), especially for children under age 6, for whom the expansions were greater.Source: Kaestner, et al., 2001.Starfield 09/02Insurance Doesn’t Guarantee Good Primary CareIncreasing Medicaid eligibility leads to greater coverage and greater presence of a regular source of care. However, black children are more likely to use poor regular sources (not doctors’ offices). Thus, just providing insurance may increase disparities between population subgroups unless good sources of primary care are available.Source: Currie & Gruber, 1996.Starfield 09/02Why is a medical home important?Starfield 09/02Insurance Doesn’t Guarantee Good Primary CareAbout 90% of children are insured.About 90% have a regular source of care.BUT less than 50% of young children have a regular doctor.Source: NSECH, 2002Starfield 09/02Odds Ratios* for Subsequent Hospitalization among Medicaid Patients Having Continuity with Regular Doctor, Delaware, 1993-5All conditions 0.56Ambulatory care sensitive conditions 0.66*after control for sociodemographic characteristicsSource: Gill & Mainous, 1998.Starfield 03/02Factors Influencing the Likelihood of Seeing a Physician, US Children, Ages 11-17† Odds RatioRace (African American) NSEthnicity (Hispanic) NSFamily Income Middle* NS Low** NSInsurance Uninsured NSUsual source of care (yes) 1.95* 200-399 % of poverty** Less than 200 % of poverty† controlled for overall health status, disability, and mental health attributes Source: Bartman et al., 1997.Starfield 1998Logistic Regression Analysis of Predictors of Delay of 90 Days or More for MMR Immunization:Northern California Kaiser Permanente, 1992 Adjusted Odds RatioNo regular doctor 2.9Lack of knowledge 2.0Number of children in family 1.4Not significant: Race, Time since appointment madeNote: All children covered by insurance Source: Lieu et al., 1994.Starfield 1998Factors Influencing the Likelihoodof Seeing a Physician in the Presenceof Symptoms, Ages 11-17† Odds RatioRace NSEthnicity NSIncome NSInsurance NSUsual source of care 1.67† controlled for overall health status, disability, and mental health attributes Source: Bartman et al., 1997. Starfield 1998Factors Related to Untimely Initiation of Prenatal Care, Low Income California Women, 1994-5*Inadequate knowledge of importance of primary care 5th birthEducation high school or lessTransportation problemsFeared disclosure of pregnancyNo regular source of care before pregnancyUnwanted/unplanned pregnancyNot significant: income, Medicaid coverage, age, race, ethnicity, smoking, stress*in order of importance (odds ratios)Source: Braveman et al., 2000.Starfield 03/02Impact of Having One Regular Source of Care,Rural Youth in Maryland, 1992Source: Ryan et al., 2001.Starfield 03/02Receipt of Routine Care by Children Whose Regular Source of Care Is a Community Health Center,US, 1988% with age-appropriate interval since last routine care visit Continuity Yes, with specific clinician 88 Yes, without specific clinician 82 No, non-CHC sick care site 80 No sick care site 76When insurance is included in a multivariable regression analysis, the adjusted odds ratio for the effect of a specific clinician on age-appropriate routine care interval was unchanged (1.84).Source: O’Malley & Forrest, 1996.Starfield 1998Does provision of the elements of primary care separately by multiple providers constitute a “medical home”?Starfield 04/02Elements of Primary CareFirst-contactOngoing person-focused care (“longitudinality”)ComprehensivenessCoordinationFamily-centerednessCommunity orientationCultural competenceStarfield 04/02Benefits of Longitudinality,Based on Evidence from the LiteratureIdentification Identificationwith a Person with a PlaceBetter problem/needs recognitionMore accurate/earlier diagnosis Better concordanceAppointment keepingTreatment adviceLess ER useFewer hospitalizationsLower costs Better prevention (some types) Better monitoring Fewer drug prescriptions Less unmet needs Increased satisfaction Evidence goodEvidence moderateSource: Starfield, 1998Starfield 11/02ConclusionInsurance is an important determinant, although not the only one, of having a medical home.Having a medical home confers many benefits, especially if the regular source is a person.Starfield 04/02
Related Documents
View more
Related Search
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks