November 12, 2011

Medical Home Setting Lowers Out-of-Pocket Costs

Larry Hand   ·  

October 17, 2011 — Parents of children with special healthcare needs pay less in out-of-pocket expenses if the children are cared for in a medical home setting, according to a report published online October 17 in Pediatrics.


Researchers from the schools of social work at the University of Missouri–St. Louis and Florida Atlantic University in Boca Raton analyzed data from the 2005 to 2006 National Survey of Children with Special Health Care Needs, including information about 31,808 children  from birth to 17 years old, 73% of whom had private insurance and 27% of whom had public insurance. The results of their study indicated that the care coordination component of the medical home helped to lower out-of-pocket medical costs per $1000 of household income.


The type of health insurance also made a difference. Parents of special-needs children with public health insurance paid on average $317 per year (1.8% of household income) compared with parents of special-needs children with private health insurance, who paid an average of $1298 per year (2.1% of household income). In addition, out-of-pocket medical expenses exceeded 5% of household income for more than 12% of families with private insurance and 10% of household income for more than 3% of those families. That compared with almost 7% and about 4% for families with public insurance.


Families with private insurance in a medical home setting spent $1088 per year (1.6% of household income), and families with public insurance spent $215 (1% of household income). However, more than 20% of families with public insurance reported that their expenses led to family financial problems, and 17% said they needed to make extra income to pay the expenses. Severity of condition led to higher costs for all survey participants.


Also, regardless of insurance type, families reported that mental healthcare, occupational or speech therapy, and dental healthcare were the highest levels of unmet needs. Families reported that cost of care was the biggest reason for delayed care and unmet needs.


The medical home concept has 7 basic principles, according to a joint statement from the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association:


Each patient has a personal physician.

The personal physician leads a team of practitioners.

The physician provides all of the patient's care or takes responsibility for other professionals.

Patient care is coordinated across all elements of the healthcare system.

Quality and safety are of utmost concern.

The patient has enhanced access to care, such as options for communication with practitioners.

Payment for care is based on added value.

The authors of the Pediatrics study concluded that the coordination of care principle applied mostly to reduced out-of-pocket expenses.


The authors have disclosed no relevant financial relationships.


Pediatrics. 2011;128:892-900.


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