PDF(Pubmed)
Abstract：
OBJECTIVE: To evaluate the effects of Medicaid Accountable Care Organizations (ACOs) on children\'s access to and utilization of health services.
METHODS: 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.
UNASSIGNED: 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.
RESULTS: 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.
METHODS: 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.
UNASSIGNED: 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.
RESULTS: 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.
摘要：
目的：评估医疗补助责任保健组织（ACO）对儿童获得和利用卫生服务的影响。
方法：本研究采用差异模型，比较了2018年至2021年的ACO和非ACO状态。获取措施是预防和疾病护理来源的指标，未满足的医疗保健需求，有私人医生或护士。利用措施是预防和牙齿护理，精神保健,专家访问,急诊部门的访问，和入院。
■次要，去识别数据来自2016-2021年全国儿童健康调查。样本包括有公共保险的儿童，根据结果，范围在21,452和37,177之间。
结果：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，集中在2018年实施ACO的州中。医疗补助ACO还与专科护理使用的增加和急诊就诊减少约5个百分点有关（后者集中在2020年实施ACO的州中）。与其他儿科结局没有明显或强烈的关联。
结论：关于MedicaidACOs与儿科获取和利用结果的关联，存在混合证据。在ACO实施后的较长时间内检查效果很重要。
方法：本研究采用差异模型，比较了2018年至2021年的ACO和非ACO状态。获取措施是预防和疾病护理来源的指标，未满足的医疗保健需求，有私人医生或护士。利用措施是预防和牙齿护理，精神保健,专家访问,急诊部门的访问，和入院。
■次要，去识别数据来自2016-2021年全国儿童健康调查。样本包括有公共保险的儿童，根据结果，范围在21,452和37,177之间。
结果：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，集中在2018年实施ACO的州中。医疗补助ACO还与专科护理使用的增加和急诊就诊减少约5个百分点有关（后者集中在2020年实施ACO的州中）。与其他儿科结局没有明显或强烈的关联。
结论：关于MedicaidACOs与儿科获取和利用结果的关联，存在混合证据。在ACO实施后的较长时间内检查效果很重要。
