Commentary on “Well-Child Care in Infancy and Healthcare Services Utilization from Birth to 6 Years by Late Preterm Children Receiving Medicaid Benefits”

Abstract

OBJECTIVES: The hypotheses tested are that healthy late preterm (LP) children receiving Medicaid benefits use more healthcare services from birth to 6 years than do full-term (FT) children and that those who make the recommended number of early and periodic screening, diagnosis, and treatment (EPSDT) visits in the first 2 years require fewer services than those with fewer visits. METHODS: Data represent all of the health encounters for a 6-year birth cohort (1996-2001) of LP and FT children in South Carolina continuously enrolled in Medicaid birth to 6 years (N = 25,940). Associations were examined between making the recommended number of EPSDT visits in the first 2 years and sick-child office visits, emergency department (ED) visits, hospital admissions and hospitalizations, and ED visits for ambulatory care-sensitive conditions (ACSCs). RESULTS: LP children used more sick-child office visits and hospital admissions (P < 0.001) from birth to 6 years than FT children. LP children with at least the recommended number of EPSDT visits had a greater adjusted rate of sick-child office visits (rate ratio 1.62, confidence interval 1.30-2.02) and a lower adjusted rate of ACSC ED visits (rate ratio 0.79, confidence interval 0.65-0.96) than those making fewer visits. Making the recommended number of EPSDT visits did not affect rates of non-ACSC ED visits or of hospitalizations. CONCLUSIONS: LP children use more healthcare services in the first 6 years of life than do FT children, and those making the recommended number of EPSDT visits may shift some of their healthcare provision from the ED to providers' offices.