Patient-Centered Medical Home And Annual Health Care Expenditures Among Children With Special Health Care Needs: New Evidence From Medical Expenditure Panel Survey


      To examine the association between having a patient-centered medical home (PCMH) and healthcare expenditures for children with special health care needs (CSHCN) in the U.S.


      We conducted a cross-sectional analysis of CSHCN in the 2008-2012 Medical Expenditure Panel Survey (MEPS) databases. MEPS identified CHSCN, while a binary PCMH indicator was constructed from parents’ survey responses following a validated algorithm.1We examined the PCMH effect on CSHCN’s annual healthcare expenditures by payers and patients with a 2-part model using logistic regression and linear regression with log-transformed costs.


      A total of 8,671 CSHCN were included in the sample. 48.7% of CSHCN reported had a PCMH. Almost all CSHCN (94.8%) incurred positive annual healthcare expenditures. CSHCN with a PCMH had higher odds of incurring any expenditures (OR=1.77, 95% CI: 1.43-2.19) -- in particular, expenditures on office visits (OR=1.47, 95% CI: 1.31-1.65) and prescriptions (OR=1.39, 95% CI: 1.25-1.55) -- compared with those without a PCMH. Conditional on positive expenditures, a PCMH was associated with higher total expenditures, as well as expenditures on outpatient care (6.9% and 28.9%; p=0.03 and p=0.01, respectively). Altogether, annual total expenditures were $3,975 for CSHCN with a PCMH, versus $3,629 for children without one.


      During the study period, CSHCN with a PCMH had higher healthcare expenditures, in particular on prescription drugs. Further research is needed to identify whether this is a causal effect between PCMHs and health care utilization for CSHCN. Reference: 1. Romaire MA, Bell JF, Grossman DC. Medical home access and health care use and expenditures among children with special health care needs. Archives of pediatrics & adolescent medicine. 2012;166(4):323-330.