A medical home could be a primary care doctor's office that incorporates the family in medical decision-making and coordinates and follows up on visits to specialists. The concept has gained popularity in recent years as a way to streamline the often complex medical situations for people with chronic illnesses. And now it appears to cut costs as well.
"This is great news," said Karen Kuhlthau, a professor at Massachusetts General Hospital for Children, who was not involved in the study. "It's nice to think that better care is more affordable for families."
In the new work, researchers tested whether having a medical home influenced how much families spent out-of-pocket on their child's medical care. The study, in the journal Pediatrics, included more than 31,000 families with a child who has a long-term condition, such as asthma, autism or allergies.
Among more than 23,000 children covered by private insurance, the average medical cost out-of-pocket was nearly $1,300 per year, or about two percent of household income. In comparison, families with a medical home -- about half of this group -- spent an average of $1,088 a year on out-of-pocket medical expenses. This translates to about 1.6 percent of the total household income. More than 8,600 children had government-funded health insurance, and those families typically spent $317 a year out-of-pocket.
Among the children in this group who had a medical home, families usually spent $215 a year out-of-pocket. Shirley Porterfield, the lead author of the study and a professor at the University of Missouri-St. Louis, said she expected to see a financial benefit to those kids who had a medical home.
"I think if you are sort of fumbling around the dark by yourself and don't have someone to help you, families might be seeing specialists that aren't particularly appropriate for their child or might be paying for a therapist that might not be as efficacious as one could be," Porterfield told Reuters Health. "This helps create a more efficient decision-making process."
The cost savings are especially important for families who spend more than five percent of their income on medical expenses -- the benchmark for what's considered unaffordable. Porterfield said she was surprised to find that 12 out of every 100 children with private insurance had medical expenses greater than five percent of their family's household income.
"The affordability piece is really huge because that plays into a lot of potential family stressors," Porterfield said. An older study has found that adult patients with a medical home also fare better, not just in lower costs, but in fewer hospital admissions, too (see Reuters Health report from September 10, 2008).
Porterfield said it's not clear whether a medical home reduces costs for children who are healthy and don't require special medical attention. That could explain why medical home services are not more widely available, she added. For instance, just four out of every 10 kids in her study who had government-funded health insurance had a medical home.
"They are out there," said Kuhlthau, "and the conversation in pediatrics and internal medicine is the medical home and their efforts to increase the number of them."Doctors are not always reimbursed by insurance companies for the extra time it takes to organize a mosaic of health care services.
The Centers for Medicare and Medicaid Services are launching a three-year demonstration project to test the performance of the medical home model among nearly 200,000 patients across the United States, starting in November.