Health care service utilization and Medicaid costs among children with and without orofacial clefts in North Carolina, 1995-2002 Public Deposited

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  • March 21, 2019
  • Cassell, Cynthia Houston
    • Affiliation: Gillings School of Global Public Health, Department of Maternal and Child Health
  • Orofacial clefts (OFC) affect about 6,800 children annually in the U.S. and one in 890 children in North Carolina. Previous studies on health service utilization and cost among children with special health care needs are limited. In 1993, the American Cleft Palate-Craniofacial Association (ACPA) developed treatment recommendations for patients with OFC. No study has examined the timeliness of services according to these guidelines. North Carolina vital statistics, birth defects registry, and Medicaid enrollment and paid claims were matched to identify resident children born 1995-2002 with (cases) and without (controls) OFC who were continuously enrolled in Medicaid. Average number of paid claims and cost per child with and without OFC were determined for medical, inpatient, outpatient, dental, well-child care, mental and home health. To determine the effect of maternal, child, and system characteristics on health service use and cost, Poisson regression and two-part modeling were employed. Multivariate logistic regression was used to examine factors associated with timely receipt of cleft surgery. Children with OFC utilized significantly more health services and had significantly greater costs than unaffected children during infancy. Total cost for children with OFC was $12,792,634 compared to $2,212,839 for unaffected children on Medicaid. Generally, characteristics associated with health service use and cost varied among categories and cases and controls. Common characteristics associated with greater service use and cost included being born low birth weight, residing in the northeastern and western regions, and receiving maternity care coordination (MCC). About 78% of children with OFC had primary cleft surgery, 51% received speech and language therapy, and fewer than 28% received other specialized services within ACPA recommendations. Timely receipt of cleft surgery varied significantly by receipt of MCC, prenatal care source, and perinatal care region. This study confirms children with OFC have significantly greater health service use and costs than unaffected children. Most children with OFC received cleft surgery, yet many did not receive specialized services within ACPA guidelines. To improve health outcomes, efforts need to be addressed to increase timely receipt of services. These results can inform policy, program development, and service planning and delivery in the state and in the U.S.
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  • Daniels, Julie
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