Mathematica Policy Research, Inc., 1100 1st Street, NE, Washington, DC 20002-4221, USA.
Matern Child Health J. 2012 Apr;16 Suppl 1:S51-60. doi: 10.1007/s10995-012-0994-y.
This study examines the relationship between total state Medicaid spending per child and measures of insurance adequacy and access to care for publicly insured children. Using the 2007 National Survey of Children's Health, seven measures of insurance adequacy and health care access were examined for publicly insured children (n = 19,715). Aggregate state-level measures were constructed, adjusting for differences in demographic, health status, and household characteristics. Per member per month (PMPM) state Medicaid spending on children ages 0-17 was calculated from capitated, fee-for-service, and administrative expenses. Adjusted measures were compared with PMPM state Medicaid spending in scatter plots, and multilevel logistic regression models tested how well state-level expenditures predicted individual adequacy and access measures. Medicaid spending PMPM was a significant predictor of both insurance adequacy and receipt of mental health services. An increase of $50 PMPM was associated with a 6-7 % increase in the likelihood that insurance would always cover needed services and allow access to providers (p = 0.04) and a 19 % increase in the likelihood of receiving mental health services (p < 0.01). For the remaining four measures, PMPM was a consistent (though not statistically significant) positive predictor. States with higher total spending per child appear to assure better access to care for Medicaid children. The policies or incentives used by the few states that get the greatest value--lower-than-median spending and higher-than-median adequacy and access--should be examined for potential best practices that other states could adapt to improve value for their Medicaid spending.
本研究考察了全国家庭医疗补助计划（Medicaid）每名儿童支出总额与保险充足性和公共保险儿童获得医疗服务之间的关系。本研究使用了 2007 年全国儿童健康调查（National Survey of Children's Health）的数据，对公共保险儿童的 7 项保险充足性和医疗服务获取措施进行了调查（n = 19715）。构建了各州的综合指标，同时调整了人口统计学、健康状况和家庭特征的差异。根据服务对象人数每月（per member per month，PMPM）的州医疗补助支出是从人头费、按服务收费和行政费用中计算得出的。对调整后的措施进行散点图比较，并通过多层次逻辑回归模型检验了州一级支出对个人充足性和获取措施的预测能力。医疗补助支出 PMPM 是保险充足性和获得心理健康服务的重要预测因素。PMPM 增加 50 美元，保险始终涵盖所需服务并允许获得服务提供者的可能性就会增加 6-7%（p = 0.04），获得心理健康服务的可能性就会增加 19%（p < 0.01）。对于其余四个措施，PMPM 是一个一致的（尽管没有统计学意义）正向预测因素。每个儿童支出总额较高的州似乎为医疗补助儿童提供了更好的医疗服务。应该研究少数几个支出低于中位数但保险充足性和获取高于中位数的州所采用的政策或激励措施，以确定其他州可以借鉴的最佳实践，从而提高其医疗补助支出的价值。
