Funded Projects

(SDAS) Medicaid Child Healthcare Quality and Cost: Need For a Paradigm Adjustment

Grantee: Medical University of South Carolina
Principal Investigator: William B. Pittard III
Project Number: R40MC17166
Project Date: 02/1/2010

Final Report

(SDAS) Medicaid Child Healthcare Quality and Cost: Need For a Paradigm Adjustment Final Report (PDF)

Age group(s)

• Perinatal/Infancy (0-12 months)
• Toddlerhood (13-35 months)
• Early Childhood (3-5 years)
• Middle Childhood (6-11 years)

Abstract

Objective. Medicaid children consistently utilize fewer than the American Academy of Pediatrics (AAP) recommended number of early and periodic screening, diagnosis, and treatment (EPSDT) or well child doctor visits in infancy, often have poor health, and frequently are not prepared for first grade learning. Because EPSDT visits provide health promotion and facilitate school readiness, well child care is designed to enhance both school and life success for children. The AAP recommendations for frequent well child visits in infancy are based on consensus expert opinion and despite AAP appeal for research documenting clinical effectiveness, excepting immunizations, well child care effectiveness has not been objectively confirmed. Because clinical effectiveness is not confirmed and the current paradigm is that correcting underuse of health care services is associated with increased cost, Medicaid policymakers are uncertain if increasing well child care in infancy is worth the added cost. In a preliminary analysis of readiness for first grade learning at the conclusion of the K-5 school year for a three year birth cohort of South Carolina Medicaid children (n=18,512), this principal investigator has noted that the children evaluated as prepared for first grade received more (p<.005) well child visits in years 1 and 2 of life than the children evaluated as not prepared. The proposed analysis is of the children in this cohort continuously enrolled in Medicaid birth-sixth birthday and tests the hypothesis that increased well child care in the first two years of life is associated with not only increased readiness for first grade learning but also reduced healthcare utilization and cost in years 1-6. Research Design and Methods. Data for this analysis will be provided by the South Carolina Budget and Control Board, Office of Research and Statistics as linked state Medicaid & claims, birth certificate records, and Department of Education files. The analysis will compare the health care utilization and cost for the children that received more well child visits in years 1 and 2 of life and were identified as ready for first grade learning with the children that received fewer well child visits and were identified as not ready for first grade learning. Variables for comparison will include the annual number of well-child (EPSDT) visits, sick child doctor visits, emergency department (ED) visits, hospital admissions, ED visits and hospital admissions for ambulatory care sensitive conditions, and Medicaid cost birth-six years. Principal needs/problems addressed. The principal need addressed by this analysis is the lack of objective evidence assessing the clinical effectiveness of infant well-child care for low income children and its associated long term cost. The postulate tested is that increased well child care in infancy is associated with improved health, reduced health care utilization, and cost birth-six years. If this hypothesis is confirmed, government policymakers can more readily support the critical public health principles of preventive/well child care and methods to increase their utilization by Medicaid children. This analysis is directly related to current MCHB Strategic Research Issues including the public health service systems and infrastructures of Medicaid, the identification and removal of cultural barriers to the provision of quality care, and the correction of characteristics disproportionately shared by Medicaid children including limited well child care utilization, poor health, and lack of readiness for first grade learning.