To determine whether children on fee-for-service Medicaid who switch primary care doctors use less health care and are less up to date with preventive care visits than children who do not switch primary care doctors.
Retrospective cohort study using Medicaid claims data.
51,027 children enrolled on Medicaid in Monroe County, New York.
14,187 children enrolled continuously on fee-for-service Medicaid between January 1992 and December 1994.
Main Outcome Measures
Utilization of primary care, emergency department (ED) services, and specialty care and proportion up to date with preventive care visits according to American Academy of Pediatrics guidelines.
During the 2-year study period, 22% of children switched primary care doctors. Compared with children who did not switch primary care doctors, those who switched had more primary care visits (4.7 vs. 3.2 visits/year,P<.01), age-adjusted preventive care visits (1.2 vs. 1.0 visits/year), ED visits (0.72 vs. 0.47 visits/year,P<.01), and specialist visits (0.99 vs. 0.31,P<.01). On multivariate analysis, doctor switching was associated with increased odds of being up to date with preventive care visits (odds ratio [OR]=1.7; 95% confidence interval [CI] 1.3 to 2.1). However, on multivariate analysis stratified by age, the association was significant only for older children (ages 11 to 14). Altogether, 68% of all children and 44% of infants less than 1 year old made the recommended number of preventive care visits during the study period.
All groups of children received less preventive care than recommended by the American Academy of Pediatrics. Children who switched primary care doctors had higher utilization of health care, including primary care, ED, and specialty care. Contrary to expectations, they were more likely to be up to date with preventive care visits. The heavy utilization of health services by doctor switchers indicates that this subgroup of children on Medicaid may not be at risk for poor access to health care, but additional research is needed to determine whether the quality of care is related to doctor switching.
The Full Text of this article is available as a PDF
These references are in PubMed. This may not be the complete list of references from this article.
1. Wood DL, Hayward RA, Corey CR, Freeman HE, Shapiro MF. Access to medical care for children and adolescents in the United States. Pediatrics. 1990;86:666–673. [PubMed] 2. Short PF, Lefkowitz DC. Encouraging preventive services for low-income children. Med Care. 1992;30:766–780. [PubMed] 3. Mustin HD, Holt VL, Connell FA. Adequacy of well-child care and immunizations in US infants born in 1988. JAMA. 1999;272:1111–1115. [PubMed] 4. Wan TTH, Gray LC. Differential access to preventive services for young children in low-income urban areas. J Health Soc Behav. 1978;19:312–324. [PubMed] 5. St. Peter RF, Newacheck PW, Halfon N. Access to care for poor children: separate and unequal? JAMA. 1992;267:2760–2764. [PubMed] 6. Newacheck PW, Halfon N. Access to ambulatory services for economically disadvantaged children. Pediatrics. 1986;78:813–819. [PubMed] 7. Newacheck PW, Halfon N. Preventive care use by school-aged children: differences by socioeconomic status. Pediatrics. 1988;82(pt 2):462–468. [PubMed] 8. Kasper JD. The importance of type of usual source of care for children's physician access and expenditures. Med Care. 1987;25:386–398. [PubMed] 9. Hughes DC, Newacheck PW, Stoddard JJ, Halfon N. Medicaid managed care: can it work for children? Pediatrics. 1995;95:591–594. [PubMed] 10. Fisher RA. Medicaid managed care: the next generation? Acad Med. 1999;69:317–322. [PubMed]
11. Freund DA, Lewitt EM. Managed care for children and pregnant women: promises and pitfalls. Future Child. 1993;3:92–122.
12. Ettner SL. The timing of preventive services for women and children: the effect of having a usual source of care. Am J Public Health. 1996;86:1748–1754. [PubMed] 13. Hayward RA, Bernard AM, Freeman HE, Corey CR. Regular source of ambulatory care and access to health services. Am J Public Health. 1990;81:434–438. [PubMed] 14. Bright RA, Avorn J, Everitt DE. Medicaid data as a resource for epidemiologic studies: strengths and limitations. J Clin Epidemiol. 1989;42:937–945. doi: 10.1016/0895-4356(89)90158-3. [PubMed] [Cross Ref]
15. Medical Directory of New York State, 1995–96. Vol. 64. Lake Success, NY: Medical Society of the State of New York; 1995.
16. American Medical Association. Directory of Physicians in the United States. 34th ed. Chicago: American Medical Association; 1994.
17. Guidelines for Health Supervision II. Elk Grove, Ill: American Academy of Pediatrics; 1988.
18. Gortmaker SL, Sappenfield W. Chronic childhood disorders: prevalence and impact. Pediatr Clin North Am. 1984;31:3–18. [PubMed]
19. Zar JH. Biostatistical Analysis. 2nd ed. Englewood Cliffs, NJ: Prentice-Hall; 1984.
20. Steinwachs DM. Measuring provider continuity in ambulatory care. Med Care. 1979;17:551–563. [PubMed] 21. Eriksson EA, Mattsson L. Quantitative measurement of continuity of care. Med Care. 1983;21:858–875. [PubMed] 22. Wolfe BL. Children's utilization of medical care. Med Care. 1980;18:1196–1207. [PubMed] 23. Bates AS, Fitzgerald JF, Dittus RS, Wolinsky FD. Risk factors for underimmunization in poor urban infants. JAMA. 1999;272:1105–1110. [PubMed] 24. Newacheck PW. Characteristics of children with high and low usage of physician services. Med Care. 1992;30:30–42. [PubMed] 25. Mustard CA, Mayer T, Black C, Post B. Continuity of pediatric ambulatory care in a universally insured population. Pediatrics. 1996;98:1028–1034. [PubMed] 26. Roghmann KJ. Use of Medicaid payment files for medical care research. Med Care. 1974;12:131–137. [PubMed] 27. Berkanovic E. An appraisal of Medicaid records as a data source. Med Care. 1974;12:590–595. [PubMed] 28. Federspiel CF, Ray WA, Schaffner W. Medicaid records as a valid data source. Med Care. 1976;14:166–172. [PubMed] 29. Roghmann KJ, Hoekelman RA, McInerny TK. The changing pattern of primary pediatric care: update from one community. Pediatrics. 1984;73:363–374. [PubMed]