Health Insurance and You!

In recent years, the idea of a ‘medical home’ has gained traction among health analysts and advocates. The American College of Physicians describes the medical home as “a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient’s lifetime to maximize health outcomes. The…practice is responsible for providing all of a patient’s health care needs or appropriately arranging care with other qualified professionals.”

According to a new study published last week in the journal Pediatrics, which focused on children with special health needs, having a centralized medical home can not only keep healthcare simpler and easier to manage, but also reduces costs. Families with special needs children spend a large portion of their income on their children’s care; according to an article on the study by Kerry Grens of Reuters, about 12% of these children have medical costs that add up to more than 5% of their family’s income.

The study authors focused on children with a variety of specific health conditions, such as asthma, ADHD, heart and blood conditions, and cystic fibrosis. The children, whose conditions ranged from mild to severe, were covered by either public or private health insurance. On average, the researchers found, privately insured families without a medical home spent $1,300 a year on their child’s medical costs, or about 2% of their total household income. In comparison, families with a medical home averaged $1,088 per year in their child’s health costs, or 1.6% of household income. Among children with public coverage, families spent an average of $317 per year, compared to $215 annually for those with a medical home.

Those savings are significant, which begs the question of why medical homes are not available everywhere. Ms. Grens has two ideas. First, there is little data on whether medical homes reduce costs for patients without special health needs, who comprise a larger part of the population. Secondly, doctors aren’t always reimbursed for the time they take to coordinate care among specialists and other referrals.

Readers, do you have a medical home? What would you do to expand the availability of these programs?