Health Serv Res. 2024 Aug 8. doi: 10.1111/1475-6773.14370. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate the effects of Medicaid Accountable Care Organizations (ACOs) on children’s access to and utilization of health services.
STUDY SETTING AND DESIGN: This study employs difference-in-differences models comparing ACO and non-ACO states from 2018 through 2021. Access measures are indicators for preventive and sick care sources, unmet healthcare needs, and having a personal doctor or nurse. Utilization measures are preventive and dental care, mental healthcare, specialist visits, emergency department visits, and hospital admissions.
DATA SOURCES AND ANALYTIC SAMPLE: Secondary, de-identified data come from the 2016-2021 National Survey of Children’s Health. The sample includes children with public insurance and ranges between 21,452 and 37,177 depending on the outcome.
PRINCIPAL FINDINGS: Medicaid ACO implementation was associated with an increase in children’s likelihood of having a personal doctor or nurse by about 4 percentage-points concentrated among states that implemented ACOs in 2018. Medicaid ACOs were also associated with an increase in specialist care use and decline in emergency visits by about 5 percentage-points (the latter being concentrated among states that implemented ACOs in 2020). There were no discernable or robust associations with other pediatric outcomes.
CONCLUSIONS: There is mixed evidence on the associations of Medicaid ACOs with pediatric access and utilization outcomes. Examining effects over longer periods post-ACO implementation is important.
PMID:39118199 | DOI:10.1111/1475-6773.14370
