title: Assessing the impact of an integrated care system on the healthcare expenditures of children with special healthcare needs.
abstract: The Children's Medical Services Network, a carved-out fee-for-service healthcare system for Florida's children with special healthcare needs (CSHCN), chose to develop an integrated care system (ICS) for its enrollees. The goals of this study were to analyze the effects of a managed care program on the Medicaid expenditures of CSHCN and to evaluate the performance of econometric models used to analyze healthcare expenditures.
  
  
  
  We used administrative data from 3947 CSHCN enrolled in Florida's Medicaid program between 2006 and 2008 for 2 treatment and 2 control counties. The 2 treatment counties were subject to the new managed care ICS.
  
  
  
  To account for the unique nature of healthcare expenditures data, 5 econometric models were constructed. Using a difference-in-differences approach, these models were used to estimate differences in healthcare expenditures between CSHCN in the reform and control counties.
  
  
  
  The ICS program decreased outpatient, inpatient, pharmacy, and total costs. These effects were statistically significant for 1 of the reform counties. Emergency department costs increased slightly, though not significantly. Among the econometric models, the generalized linear models outperformed the ordinary least squares regressions.
  
  
  
  This analysis provides evidence that managed care programs such as Florida's ICS have the potential to reduce healthcare expenditures.
authors.forename: Mircea I
authors.initials: MI
authors.lastname: Marcu
authors.forename: Caprice A
authors.initials: CA
authors.lastname: Knapp
authors.affiliation: 8-14 HM Tory Building, University of Alberta, Edmonton, AB, Canada T6G 2H4. E-mail: dpbrown@ualberta.ca.
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Madden
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000458:organization & administration; D002675:Child, Preschool; D017046:Cost Savings; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration; D019988:Children with Disabilities; D005431:Florida; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000458:organization & administration; D008484:Medicaid / Q000191:economics* / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States