David L DiGiuseppe1, Dimitri A Christakis. 1. Department of Pediatrics, Child Health Institute, University of Washington, Seattle, WA 98195-4920, USA. davdig@u.washington.edu
Abstract
OBJECTIVE: To compare the continuity of care experienced by children who are in foster care with that of children who are not in foster care and are covered under Medicaid managed care and Medicaid fee-for-service (FFS). METHODS: This retrospective cohort study used Medicaid claims/encounter data from Washington state. A total of 903 children who were in foster care and continuously enrolled in Medicaid for 24 months (1998-1999) were matched by age, gender, and rural/urban residence to 903 Medicaid managed care enrollees and 903 FFS beneficiaries who were not in foster care. Indices of the continuity of primary care experienced were calculated for each patient, and differences in continuity among the cohorts were assessed by running 3 multiple linear regression models for all possible pairings of cohorts, controlling for age, gender, rural/urban residence, and total number of primary care visits. RESULTS: Foster care status was associated with decreased continuity of care relative to nonfoster managed care status (beta = -0.12; 95% confidence interval [CI]: -0.15 to -0.09). Nonfoster FFS status was associated with lower continuity than managed care (beta = -0.09; 95% CI: -0.12 to -0.06) and slightly higher continuity than foster care status (beta = 0.03; 95% CI: 0.01-0.06). CONCLUSION: Although not dramatically different, continuity seems somewhat lacking for children in foster care. It is unclear to what degree the observed difference is confounded by the managed care/FFS distinction. As the enrollment of children in foster care into managed care plans has been controversial, efforts to promote the consistency of contact with providers while maintaining the flexibility afforded by FFS coverage seem warranted.
OBJECTIVE: To compare the continuity of care experienced by children who are in foster care with that of children who are not in foster care and are covered under Medicaid managed care and Medicaid fee-for-service (FFS). METHODS: This retrospective cohort study used Medicaid claims/encounter data from Washington state. A total of 903 children who were in foster care and continuously enrolled in Medicaid for 24 months (1998-1999) were matched by age, gender, and rural/urban residence to 903 Medicaid managed care enrollees and 903 FFS beneficiaries who were not in foster care. Indices of the continuity of primary care experienced were calculated for each patient, and differences in continuity among the cohorts were assessed by running 3 multiple linear regression models for all possible pairings of cohorts, controlling for age, gender, rural/urban residence, and total number of primary care visits. RESULTS: Foster care status was associated with decreased continuity of care relative to nonfoster managed care status (beta = -0.12; 95% confidence interval [CI]: -0.15 to -0.09). Nonfoster FFS status was associated with lower continuity than managed care (beta = -0.09; 95% CI: -0.12 to -0.06) and slightly higher continuity than foster care status (beta = 0.03; 95% CI: 0.01-0.06). CONCLUSION: Although not dramatically different, continuity seems somewhat lacking for children in foster care. It is unclear to what degree the observed difference is confounded by the managed care/FFS distinction. As the enrollment of children in foster care into managed care plans has been controversial, efforts to promote the consistency of contact with providers while maintaining the flexibility afforded by FFS coverage seem warranted.