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FINAL REPORT Evaluation of Healthcare Costs and Utilization

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FINAL REPORT Evaluation of Healthcare Costs and Utilization University of Cincinnati Medical Center College of Pharmacy Health Economics & Outcomes Research FINAL REPORT Evaluation of Healthcare Costs and Utilization among Medicaid Recipients in Schools with School-Based Health Centers SUBMITTED TO THE HEALTH FOUNDATION OF GREATER CINCINNATI by Jeff J. Guo, B.Pharm., Ph.D.1,2 Raymond Jang, Ph.D. 1 Robert J. Cluxton, Pharm.D. 1,2 1 College of Pharmacy 2 Institute of Health Policy and Health Services Research University of Cincinnati Medical Center, Cincinnati, Ohio 3223 Eden Ave. Cincinnati, Ohio Tel. (513) 558-8613 Copyright © 2005 by The Health Foundation of Greater Cincinnati. All rights reserved. To cite this work, please follow this format: Health Foundation of Greater Cincinnati, The (2005). Evaluation of Healthcare Costs and Utilization among Medicaid Recipients in Schools with School-Based Health Centers. Cincinnati, OH: Author. Permission is granted to reproduce this publication provided that these reproductions are not used for a commercial purpose, that you do not collect any fees for the reproductions, that our materials are faithfully reproduced (without addition, alteration, or abbreviation), and that they include any copyright notice, attribution, or disclaimer appearing on the original. Final Report of SBHC Cost Study 2 Table of Contents I. INTRODUCTION ............................................................................................................. 12 Specific Aims and Hypotheses .............................................................................................. 13 Background and Significance ................................................................................................ 14 Significance of This Study .................................................................................................... 17 II. METHODOLOGY ............................................................................................................ 19 Study Design ........................................................................................................................ 19 Consent for Evaluation and IRB Approval ............................................................................ 19 Data Sources and Study Period ............................................................................................. 20 Target Population and Study Groups ................................................................................... 21 Theoretical Models ............................................................................................................... 22 Total Medicaid expenses: .................................................................................................. 22 Inflation Adjusted Discount Factor: .................................................................................. 25 Function of Medicaid Expenses per Recipient: .................................................................. 25 Theoretical Model of Cost-Benefit Analysis .......................................................................... 29 Questionnaire for Cost-Benefit Variables .......................................................................... 34 Study Subgroups: Cohort Study for Students with Chronic Diseases .................................... 35 Statistical Analyses ................................................................................................................ 37 III. RESULTS – Aim#1 ........................................................................................................... 41 Demographics ...................................................................................................................... 41 Trends for Medicaid Total Costs by SBHC .......................................................................... 42 Final Report of SBHC Cost Study 3 Total Medicaid Costs for Students before and after SBHC Program ..................................... 47 Hospitalization Costs Before and After SBHC Program ....................................................... 49 Costs of Emergency department Visits Before and After SBHC Program ............................. 49 Costs for Mental Health Services Before and After SBHC Program ...................................... 50 Prescription Drug Costs Before and After SBHC Program ................................................... 51 Dental Care Costs Before and After SBHC Program ............................................................ 52 Growth Curve Analysis (Hierarchical Linear/Nonlinear Modeling) for Total Medicaid Costs ................................................................................................. 54 Rates of Hospitalization Before and After SBHC Program ................................................... 60 Rates of Emergency department Visits Before and After SBHC Program .............................. 60 IV. RESULTS – Aim#2 ........................................................................................................... 62 Cohort Study for Students with Asthma ............................................................................... 62 Risk of Hospitalization and ED visits for Students with Asthma ........................................... 63 Costs of Hospitalization and ED visits for Students with Asthma ......................................... 65 Cohort Study for Students with Mental Health Problems .................................................... 66 Total Costs for Students with Mental Health Problems ........................................................ 68 V. RESULTS – Aim#3 ............................................................................................................ 69 Cost-Benefit Analysis for the SBHC Program ....................................................................... 69 Economic Outcomes from 3 years of SBHC Operations in Four School Districts ............. 70 Value of Additional Outside Sources of Funding .............................................................. 70 Estimation of the Value of Outcomes as Benefits .............................................................. 71 Net Social Benefit Estimation ........................................................................................... 77 Final Report of SBHC Cost Study 4 VI. Discussion .......................................................................................................................... 78 Total Costs and Effectiveness of SBHC Program .................................................................. 78 Effectiveness of SBHC Program on Hospitalization and ED Visits for Asthma Cohort Students ............................................................................................................................... 81 Effectiveness of SBHC Program on Primary Care for Students with Mental Health Problems ............................................................................................. 82 Cost-Benefit Analysis for the SBHC Program: Societal Perspective vs. Medicaid Perspective 84 Health Policy Implications ................................................................................................... 87 Limitations ........................................................................................................................... 88 Conclusions .......................................................................................................................... 89 ACKNOWLEDGMENTS ...................................................................................................... 91 VI. REFERENCES: ................................................................................................................. 92 Tables .............................................................................................................................................98 Figures ..........................................................................................................................................129 Appendix A: “Parent Survey Name” .............................................................................................. Appendix B: School-Based Health Center Coordinator’s Survey: Resource Use for SBHC Implementation 2000–2003 ................................................................................................. Appendix C: Brand-Names and Generic-Names of Medications for Asthma Treatment ............... Appendix D: International Classification of Disease (ICD-9) Codes of Mental Illnesses ............... Appendix E: Brand-Names and Generic-Names of Medications for Mental Health Therapy ........... Final Report of SBHC Cost Study 5 List of Tables Table 1. Summary of Published Major Studies on School-Based Health Centers (SBHCs) Table 2. Demographics and Medicaid Enrollment for Students in Intervention and Comparison Schools Table 3. Costs for All Students Enrolled in Medicaid and Schools from 9/1997 to 2/2003 (N=5,056) Table 4. Repeated Measures ANCOVA of Means of Total Costs for Students in Intervention and Comparison Schools (N =2,153) Table 5. Repeated Measures ANCOVA of Hospitalization Costs for Students in Intervention and Comparison Schools (N =2,153) Table 6. Repeated Measures ANCOVA of Emergency Department Costs for Students in Intervention and Comparison Schools (N =2,153) Table 7. Repeated Measures ANCOVA of Mental Health Service Costs for Students in Intervention and Comparison Schools (N =2,153) Table 8. Repeated Measures ANCOVA of EPSDT Costs for Students in Intervention and Comparison Schools (N=2,153)
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