Health Care Use and Spending of Pediatric Patients With an Intellectual or Developmental Disability.

Abstract

Health care costs and utilization for those with an intellectual or developmental disability (IDD) have been shown to be higher than the general population. To investigate the services that contribute to higher costs and utilization among noninstitutionalized children with an IDD. Matched case-control secondary analysis of the 2000-2017 Medical Expenditure Panel Survey. Pediatric (age 0-21) patients with an IDD were matched to non-IDD subjects. Health care utilization and costs were evaluated with zero-inflated negative binomial regressions and generalized linear models, respectively. Outcome measures included high-acuity health care utilization [ie, emergency department (ED) visits and hospital admissions], and cost outcomes for total spending, ED use, hospitalization, medications, office visits, home health, and physical therapy. There was no statistical difference in utilization of EDs among the 2 groups though subjects with an IDD showed more hospitalizations than their matched cohort (incidence rate ratios=1.63, P=0.00). Total health care spending was higher among patients with an IDD (coefficient=$5831, P=0.00). Pediatric spending was higher in all measures except for ED. The biggest discrepancies in spending were seen in home health (coefficient=$2558, P=0.00) and outpatient visits (coefficient=$1180, P=0.00). Pediatric patients with an IDD had higher health care spending and utilization than non-IDD subjects in all categories except for ED use.