Differences in use of health services between White and African American children enrolled in Medicaid in North Carolina.

OBJECTIVES: Racial differences in health status and use of health services persist in the United States and are not completely explained by differences in socioeconomic status. This study examines differences in use of health services between White and African American children enrolled in Medicaid, controlling for other factors that affect service use. We make comparisons for use of primary preventive services, diagnosis and treatment of selected common childhood illnesses, and Medicaid expenditures. METHODS: We linked Medicaid enrollment records, Medicaid paid claims data, and data on use of child WIC services to birth certificates for North Carolina children born in 1992 to measure use of health services and Medicaid expenditures by race for children ages 1, 2, 3, and 4. Logistic and Tobit regression models were used to estimate the independent effect of race, controlling for other variables such as low birth weight, WIC participation, and mother's age, education, and marital status. Since all children enrolled in Medicaid are in families of relatively low income, racial differences in socioeconomic status are partially controlled. RESULTS: African American children had consistently lower Medicaid expenditures and lower use of health services than did White children, after statistically controlling for other maternal and infant characteristics that affect health service use, including child WIC participation. For example, total annual Medicaid expenditures were 207-303 dollars less for African American children than for White children, controlling for other variables. African America children were significantly less likely to receive well-child and dental services than were White children. CONCLUSIONS: African American children enrolled in Medicaid use health services much less than White children, even when controlling for socioeconomic status and other factors that affect service use. Linking state administrative databases can be a cost-effective way of addressing important issues such as racial disparities in health service use.

Child participation in WIC: Medicaid costs and use of health care services.

OBJECTIVES: We used data from birth certificates, Medicaid, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to examine the relationship of child participation in WIC to Medicaid costs and use of health care services in North Carolina. METHODS: We linked Medicaid enrollment, Medicaid paid claims, and WIC participation files to birth certificates for children born in North Carolina in 1992. We used multiple regression analysis to estimate the effects of WIC participation on the use of health care services and Medicaid costs. RESULTS: Medicaid-enrolled children participating in the WIC program showed greater use of all types of health care services compared with Medicaid-enrolled children who were not WIC participants. CONCLUSIONS: The health care needs of low-income children who participate in WIC may be better met than those of low-income children not participating in WIC.