Urban/Rural Differences in Therapy Service Use Among Medicaid Children Aged 0-3 With Developmental Conditions in...

Area of Science:

• Pediatric Health Services Research
• Developmental Pediatrics
• Health Disparities

Background:

• Access to physical therapy (PT) and occupational therapy (OT) is crucial for young children with developmental conditions.
• Urban and rural disparities in healthcare access and utilization are well-documented but require specific examination for pediatric therapy services.

Purpose of the Study:

• To investigate urban-rural differences in the utilization and spending of physical (PT) and occupational therapy (OT) services.
• To analyze these differences among young children enrolled in Medicaid with diagnosed developmental conditions.

Main Methods:

• Analysis of administrative claims data from Colorado's Children's Medicaid program (2006-2008).
• Inclusion of children under 36 months with a developmental condition, continuously eligible for Medicaid until age three.
• Multivariable analyses adjusted for child, family, and healthcare characteristics to compare PT/OT utilization and spending between urban and rural groups.

Main Results:

• Urban children (n=20,959) had double the odds of receiving PT/OT compared to rural children (OR 2.18).
• Median annual per-child Medicaid PT/OT spending was significantly higher for urban children ($98.79 more).
• The spending gap narrowed when considering the specific location and type of PT/OT procedures utilized.

Conclusions:

• Rural children enrolled in Medicaid with developmental conditions utilize fewer PT/OT services and incur lower spending compared to their urban counterparts.
• The observed spending difference is primarily linked to the utilization of less specialized therapy services in rural areas.
• Findings suggest potential disparities in access to appropriate and specialized pediatric physical and occupational therapy services for rural children.