title: Medical home and out-of-pocket medical costs for children with special health care needs.
abstract: OBJECTIVE
  We examined key factors that affect out-of-pocket medical expenditures per $1000 of household income for children with special health care needs (CSHCN) with a broad range of conditions, controlling for insurance type and concentrating on the potentially moderating role of the medical home.
  
  
  METHODS
  A Heckman selection model was used to estimate whether the medical home influenced out-of-pocket medical costs per $1000 of household income for children covered by either private or public health insurance. Data from the 2005-2006 National Survey of CSHCN (N = 31,808) were used.
  
  
  RESULTS
  For families that incurred out-of-pocket medical costs for their CSHCN, these costs represented 2.2% to 3.9% of income. Both insurance type and the medical home had significant effects on out-of-pocket costs. Lower out-of-pocket medical costs per $1000 of income were incurred by children with public insurance and those receiving care coordination services.
  
  
  CONCLUSIONS
  Families with CSHCN incur lower out-of-pocket medical costs when their children receive health care in a setting in which the care-coordination component of the medical home is in place.
authors: School of Social Work, University of Missouri-St Louis, St Louis, MO 63121, USA. porterfields@umsl.edu
authors: Shirley L
authors: SL
authors: Porterfield
authors: LeaAnne
authors: L
authors: DeRigne
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data; D002669:Child Welfare; D002675:Child, Preschool; D017281:Cost of Illness; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D020380:Needs Assessment; D018802:Patient-Centered Care / Q000191:economics* / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States