The Impact of Type of Foster Care Placement On Utilization of Health Care

Background and Purpose:  Children in foster care have more chronic conditions, developmental and mental health problems than any comparable children's group in America. To address these needs, foster children in Illinois are enrolled in a medical home system. Although prior comparative effectiveness research has found that children in foster care fare better with respect to accessing preventative care, the way in which different types of placements— traditional foster care (TFC), relative foster care (RFC), and congregate care (CC)— affect the utilization of health care for these children is unknown. Understanding difference in utilization patterns by types of placements may help target strategies and to advance the medical home model.  The purpose of this study is to assess if type of placement for a child in foster care affects their utilization of health care.

 Methods:  Illinois Department of Children and Family Services compared Medicaid paid claims data of children in foster care and other children in Medicaid from 2002-10. In addition, foster children in different types of living arrangements for a 12-month period were analyzed. Logistic regressions stratified by the presence of chronic conditions (none, only physical conditions, only mental conditions, both) were used to calculate the adjusted odds of receiving different types of service across groups.

 Results:   Depending on chronic condition category, children in each type of foster care were significantly more likely to receive well child-care (odds ratios (OR) 1.3-4.3; p<.001) and dental care (OR 1.7-9.4; p<.001) compared with other Medicaid eligible children in Illinois.  In most cases, children in RFC and TFC were slightly less likely to be seen in the Emergency Department (ED) (OR 0.48-0.86; p<.001) than other  Medicaid eligible children. When directly comparing types of foster care placements, children in RFC without prior chronic conditions were more 18% likely to be seen in the ED (OR 1.18; p<.001).  Those children with chronic physical conditions living in RFC were 30% more likely to be hospitalized (OR 1.3; p<.001). Children in CC were significantly less likely to receive well-child care (OR 0.39-0.63; p<.001) and more likely to use the ED (OR 1.5-2.23; p<.001) and require hospitalization (OR1.9-3.9; p<.001) compared with children in TFC.   

 Conclusions:   Although, children in TFC and RFC were just as likely to receive preventative health care, those in RFC were more like to use the ED and to be hospitalized. Children in RFC and CC may benefit in terms of health promotion and cost savings from the implementation of care coordination for children in foster care under the Fostering Connections to Success and Increasing Adoptions Act of 2008 (PL No. 110-354).  The analysis demonstrates a significant association between foster care settings and health service utilization that warrants further inquiry.