Neighborhood opportunities and pediatric health care utilization: implications for Medicaid managed care

Disparities in health care utilization exist, particularly among children in socially disadvantaged neighborhoods. This study examined the relationship between neighborhood opportunity and health care utilization among pediatric Medicaid managed care beneficiaries, identifying key areas for interventions to address disparities and improve pediatric health outcomes.

We conducted a retrospective cross-sectional analysis of a merged 2022 administrative claims data set with the Child Opportunity Index (COI) 3.0 database for Medicaid managed care beneficiaries younger than 21 years who were continuously enrolled for 12 months (N = 157,261).

Generalized linear models (logistic regression and zero-inflated negative binomial regression) were used to examine the association between neighborhood opportunities and health care utilization (measured by primary care physician [PCP] visits, emergency department [ED] visits, and hospitalizations) while adjusting for confounders.

Compared with those in high-opportunity neighborhoods, pediatric beneficiaries in very low-, low-, and moderate-opportunity neighborhoods were 11.5 percentage points, 5.1 percentage points, and 2.2 percentage points less likely to have PCP visits, respectively, and 1.4 times, 1.2 times, and 1.1 times more likely to visit the ED. Hospitalizations were 0.5 percentage points more likely in very low-opportunity neighborhoods.

The results corroborate that health care utilization varies by neighborhood opportunity levels. Managed care organizations can use the COI to address disparities in pediatric beneficiaries' health care utilization. Findings underscore the differences in health care utilization that may be a basis for researchers, policy analysts, and decision makers to further investigate underlying unmet needs that affect pediatric health care utilization in lower opportunity neighborhoods.