Reliance on Acute Care Settings for Health Care Utilization: A Comparison of Adolescents With Younger Children.

Document Type

Article

Publication Date

12-1-2021

Identifier

DOI: 10.1097/PEC.0000000000001924

Abstract

OBJECTIVE: Because a goal of the Affordable Care Act was to increase preventive care and reduce high-cost care, the objective of this study was to evaluate current health care use and reliance on acute care settings among Medicaid-enrolled children.

METHODS: This was a retrospective cohort study of the 2015 Truven Marketscan Medicaid claims database among children 0 to 21 years old with at least 11 months of continuous enrollment. We calculated adjusted probabilities of health care use (any health care use and ≥1 health maintenance visit) and high acute care reliance (ratio of emergency department or urgent care visits to all health care visits >0.33) by age and compared use between adolescents and younger children using multivariable logistic regression.

RESULTS: Of the 5,182,540 Medicaid-enrolled children, 18.9% had no health care visits and 47.3% had 1 or more health maintenance visit in 2015. Both health care use and health maintenance visits decreased with increasing age (P < 0.001). Compared with younger children (0-10 years old), adolescents were more likely to have no interaction with the health care system [adjusted odds ratio (aOR), 2.20; 95% confidence interval (CI), 2.19-2.21] and less likely to have health maintenance visits (aOR, 0.40; 0.39-0.40). High acute care reliance was associated with increasing age, with adolescents having greater odds of high acute care reliance (aOR, 1.08; 1.08-1.09).

CONCLUSIONS: Medicaid-enrolled adolescents have low rates of health care use and have high reliance on acute care settings. Further investigation into adolescent-specific barriers to health maintenance care and drivers for acute care is warranted.

Journal Title

Pediatric emergency care

Volume

37

Issue

12

First Page

1128

Last Page

1132

MeSH Keywords

Adolescent; Adult; Ambulatory Care; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Medicaid; Patient Acceptance of Health Care; Patient Protection and Affordable Care Act; Retrospective Studies; United States; Young Adult

Keywords

Ambulatory Care; Medicaid; Patient Acceptance of Health Care; Patient Protection and Affordable Care Act; Retrospective Studies

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