Effects of Medicaid Accountable Care Organizations on children's access to and utilization of health services
研究了2018至2021年间医疗补助责任医疗组织（ACO）对儿童健康服务可及性和利用的影响，发现ACO增加了拥有个人医生或护士的可能性，并提高了专科服务使用、减少了急诊就诊。
OBJECTIVE: To evaluate the effects of Medicaid Accountable Care Organizations (ACOs) on children's access to and utilization of health services. STUDY SETTING AND DESIGN: This study employs difference-in-differences models comparing ACO and non-ACO states from 2018 through 2021. Access measures are indicators for preventive and sick care sources, unmet healthcare needs, and having a personal doctor or nurse. Utilization measures are preventive and dental care, mental healthcare, specialist visits, emergency department visits, and hospital admissions. DATA SOURCES AND ANALYTIC SAMPLE: Secondary, de-identified data come from the 2016-2021 National Survey of Children's Health. The sample includes children with public insurance and ranges between 21,452 and 37,177 depending on the outcome. PRINCIPAL FINDINGS: Medicaid ACO implementation was associated with an increase in children's likelihood of having a personal doctor or nurse by about 4 percentage-points concentrated among states that implemented ACOs in 2018. Medicaid ACOs were also associated with an increase in specialist care use and decline in emergency visits by about 5 percentage-points (the latter being concentrated among states that implemented ACOs in 2020). There were no discernable or robust associations with other pediatric outcomes. CONCLUSIONS: There is mixed evidence on the associations of Medicaid ACOs with pediatric access and utilization outcomes. Examining effects over longer periods post-ACO implementation is important.