title: Evaluating the Impact of Parent-Reported Medical Home Status on Children's Health Care Utilization, Expenditures, and Quality: A Difference-in-Differences Analysis with Causal Inference Methods.
abstract: To evaluate the effects of the parent-reported medical home status on health care utilization, expenditures, and quality for children.
  
  
  
  Medical Expenditure Panel Survey (MEPS) during 2004-2012, including a total of 9,153 children who were followed up for 2 years in the survey.
  
  
  
  We took a causal difference-in-differences approach using inverse probability weighting and doubly robust estimators to study how changes in medical home status over a 2-year period affected children's health care outcomes. Our analysis adjusted for children's sociodemographic, health, and insurance statuses. We conducted sensitivity analyses using alternative statistical methods, different approaches to outliers and missing data, and accounting for possible common-method biases.
  
  
  
  Compared with children whose parents reported having medical homes in both years 1 and 2, those who had medical homes in year 1 but lost them in year 2 had significantly lower parent-reported ratings of health care quality and higher utilization of emergency care. Compared with children whose parents reported having no medical homes in both years, those who did not have medical homes in year 1 but gained them in year 2 had significantly higher ratings of health care quality, but no significant differences in health care expenditures and utilization.
  
  
  
  Having a medical home may help improve health care quality for children; losing a medical home may lead to higher utilization of emergency care.
authors.affiliation: RAND Corporation, Santa Monica, CA.
authors.forename: Bing
authors.initials: B
authors.lastname: Han
authors.affiliation: RAND Corporation, Pittsburgh, PA.
authors.forename: Hao
authors.initials: H
authors.lastname: Yu
authors.affiliation: RAND Corporation, Boston, MA.|Brigham and Women's Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Friedberg
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000191:economics / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Medical home; children; difference-in-differences; expenditures; quality of care; utilization