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Annual Days With a Health Care Encounter for Children and Youth Enrolled in Medicaid: A Multistate Analysis
Brigid M Garrity1, James M Perrin2, Jonathan Rodean3
1Division of General Pediatrics, Boston Children's Hospital (BM Garrity, A Desmarais, and JG Berry), Boston, Mass.
Insights
A study found that 10% of children in Medicaid had healthcare encounters at least once weekly, with 1% seeing doctors most weekdays. Frequent encounters correlated with co-occurring mental and physical health conditions.
Area of Science:
- Pediatric Health Services Research
- Health Economics
- Chronic Disease Management
Background:
- Understanding healthcare utilization patterns in pediatric populations is crucial for resource allocation and care coordination.
- Medicaid beneficiaries represent a significant population with complex health needs.
- Chronic conditions in children often lead to increased healthcare demands.
Purpose of the Study:
- To determine the annual number of healthcare encounter days for children enrolled in Medicaid.
- To investigate the association between different types of chronic conditions and the frequency of healthcare encounters.
- To identify patterns of healthcare utilization among high-need pediatric populations.
Main Methods:
- Retrospective analysis of Medicaid data for over 5 million children (ages 0-18) in 2017.
- Categorization of encounter days by health service type.
- Utilized International Classification of Disease-10 codes and the Agency for Healthcare Research and Quality's Chronic Condition Indicator System to identify chronic conditions.
Main Results:
- The median annual healthcare encounter days was 6 (IQR 2-13).
- Children in the top percentiles (91st-98th and ≥99th) accounted for 52.6% of all encounter days, with medians of 49 and 229 days, respectively.
- Increased encounter days correlated with a higher prevalence of co-existing mental and physical health conditions (up to 47.4% in the highest percentile). Outpatient visits constituted the majority of encounters for high-utilization groups.
Conclusions:
- Ten percent of Medicaid-enrolled children experienced healthcare encounters at least weekly, and 1% had encounters on most weekdays.
- Frequent healthcare utilization is strongly linked to the presence of multiple chronic conditions.
- Further research is needed to understand family perspectives on frequent healthcare encounters and to optimize care delivery for these children.
Objective:
To assess the number of days that children experienced a health care encounter and associations between chronic condition types and health care encounters.
Methods:
Retrospective analysis of data from 5,082,231 children ages 0 to 18 years enrolled in Medicaid during 2017 in 12 US states contained in the IBM Watson Marketscan Medicaid Database. We counted and categorized enrollees' encounter days, defined as unique days a child had a health care visit, by type of health service. We used International Classification of Disease-10 diagnosis code categories from Agency for Healthcare Research and Quality's Chronic Condition Indicator System to identify chronic mental and physical health conditions.
Results:
Median (interquartile range [IQR]) annual encounter days was 6 (2-13). Children in the 91st to 98th and ≥99th percentiles for encounter days experienced a median of 49 (IQR 38-70) and 229 (IQR 181, 309) days, respectively; these children accounted for 52.6% of days for the cohort. As encounter days increased from the 25th to >90th percentile, the percentage of children with co-existing mental and physical health conditions increased from <0.1% to 47.4% (P < .001). Outpatient visits accounted for a total of 68.3% and 62.2% of days for children the 91st to 98th and ≥99th percentiles.
Conclusion:
Ten percent of children enrolled in Medicaid averaged health care encounters at least 1 day per week; 1% experienced health care encounters on most weekdays. Further investigation is needed to understand how families perceive frequent health care encounters, including how to facilitate their children's care in the most feasible way.
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