The Centrality of Complexity in Children's Longitudinal Health Care Spending.

Abstract

How much health care will a child use in a given year? This question has profound implications for children and families, often in the context of acute illness and also in efforts to prevent disease with anticipatory guidance and preventive strategies such as routine vaccination. For children with chronic health conditions, anticipating health care utilization often has an additional double-sided layer of meaning: families hope that their children will have access to all the health care they need, while also hoping that their needs will be less than they expect. The health and emotional dimensions of anticipating children’s health care utilization are further colored with economic considerations. This is certainly the case at the family level, where parents often struggle to cope with the costs of health care not fully covered by private insurers or public programs. Economic concerns also strongly influence decisions by payers such as Medicaid and by health care providers such as hospitals and health systems. Among such stakeholders, there has been strong interest in trying to identify children who are likely to have high health care utilization, for purposes of implementing care coordination and other interventions based on published evidence. For instance, an outpatient-based medical home program at a children’s hospital, focusing on children with multiple chronic conditions and offering care coordination during hospitalizations, was found to reduce hospitalization frequency and shorten hospital stays while increasing outpatient encounter frequency, with an overall savings compared with management of the same children before the intervention.1 An analysis of national Medicaid spending for children with medical complexity indicated that reductions in hospital lengths of stay would have the greatest potential for cost offsets that could support intensification of primary care–based case coordination, compared … Address correspondence to Matthew M. Davis, MD, MAPP, Ann and Robert H. Lurie Children’s Hospital, 225 E. Chicago Ave, Chicago, IL 60611. E-mail: mmdavis{at}luriechildrens.org