IMPACT OF CARE SETTING ON COST AND QUALITY UNDER MEDICAID

Medicaid claims data were used to compare the costs and care quality o f ambulatory visits for two childhood illnesses, urinary tract infecti on (UTI) and suppurative otitis media (OM), in the fee-for-service Med icaid program in Alabama across three care settings: offices where pat ients had been seen before, offices where patients had not been seen b efore, and outpatient hospital departments. Forty percent of UTI visit s and 46 percent af OM visits occurred in return office settings. Visi ts to outpatient hospital and first-time office settings were more exp ensive than those to return office settings, due to the billing of fac ility fees and the provision of additional services. Adherence to comm on measures of quality of care for both types of visits was few; 52 pe rcent of UTI visits included urine cultures and 40 percent of OM visit s included recheck visits. Adherence to these quality measures was sig nificantly lower in visits occuring in hospital settings.