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Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic
David Y Ming1,2,3, Kelley A Jones4, Michelle J White5
1Department of Medicine, Duke University School of Medicine, Durham, NC, USA. david.ming@duke.edu.
Insights
Healthcare use for children with medical complexity (CMC) on Medicaid varied significantly by race/ethnicity and rurality. Black CMC had higher hospital and ED use, while Hispanic CMC had lower rates. Rural CMC showed increased ED visits.
Area of Science:
- Health Services Research
- Pediatric Health
- Health Equity
Background:
- Children with medical complexity (CMC) represent a significant population within Medicaid.
- Understanding disparities in healthcare utilization and costs is crucial for equitable care delivery.
- Previous research has not fully elucidated variations by race/ethnicity and rurality in this population.
Purpose of the Study:
- To compare healthcare utilization and costs among Medicaid-insured CMC based on race/ethnicity and rurality.
- To identify specific patterns of acute care, outpatient care, and pharmacy use.
- To inform targeted interventions for improving care for diverse CMC populations.
Main Methods:
- Retrospective cohort analysis of North Carolina Medicaid claims (2015-2019).
- Inclusion of children aged 3-20 with 3 years of continuous coverage, categorized by medical complexity.
- Comparison of utilization rates (hospitalization, ED, outpatient, pharmacy) adjusted for race/ethnicity and rurality.
Main Results:
- Among 118,210 CMC, Black non-Hispanic CMC had higher hospitalization and ED visit rates compared to White non-Hispanic CMC.
- Hispanic CMC showed lower ED visit and hospitalization rates than White non-Hispanic CMC.
- Rural CMC experienced higher ED utilization and lower primary care use compared to urban CMC.
Conclusions:
- Significant variations in healthcare utilization exist for Medicaid-insured CMC based on race/ethnicity and rurality.
- Further research is needed to explore the underlying mechanisms driving these disparities.
- Efforts should focus on expanding high-value, equitable care delivery models for CMC.
Objective:
To compare differences in healthcare utilization and costs for Medicaid-insured children with medical complexity (CMC) by race/ethnicity and rurality.
Methods:
Retrospective cohort of North Carolina (NC) Medicaid claims for children 3-20 years old with 3 years continuous Medicaid coverage (10/1/2015-9/30/2018). Exposures were medical complexity, race/ethnicity, and rurality. Three medical complexity levels were: without chronic disease, non-complex chronic disease, and complex chronic disease; the latter were defined as CMC. Race/ethnicity was self-reported in claims; we defined rurality by home residence ZIP codes. Utilization and costs were summarized for 1 year (10/1/2018-9/30/2019) by complexity level classification and categorized as acute care (hospitalization, emergency [ED]), outpatient care (primary, specialty, allied health), and pharmacy. Per-complexity group utilization rates (per 1000 person-years) by race/ethnicity and rurality were compared using adjusted rate ratios (ARR).
Results:
Among 859,166 Medicaid-insured children, 118,210 (13.8%) were CMC. Among CMC, 36% were categorized as Black non-Hispanic, 42.7% White non-Hispanic, 14.3% Hispanic, and 35% rural. Compared to White non-Hispanic CMC, Black non-Hispanic CMC had higher hospitalization (ARR = 1.12; confidence interval, CI 1.08-1.17) and ED visit (ARR = 1.17; CI 1.16-1.19) rates; Hispanic CMC had lower ED visit (ARR = 0.77; CI 0.75-0.78) and hospitalization rates (ARR = 0.79; CI 0.73-0.84). Black non-Hispanic and Hispanic CMC had lower outpatient visit rates than White non-Hispanic CMC. Rural CMC had higher ED (ARR = 1.13; CI 1.11-1.15) and lower primary care utilization rates (ARR = 0.87; CI 0.86-0.88) than urban CMC.
Discussion:
Healthcare utilization varied by race/ethnicity and rurality for Medicaid-insured CMC. Further studies should investigate mechanisms for these variations and expand higher value, equitable care delivery for CMC.
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