Health Care Expenditures For Children Research Articles

A medical home for children in foster care reduces expenditures

ABSTRACT Children in foster care are at risk from fragmented care, delayed access, medical complexity, and increased mental health needs. We studied health care expenditures for children in foster care managed by a Patient-Centered Medical Home foster care specialty clinic (Fresh Start). We used Alabama Medicaid claims data from 2016 to 2018 to compare the costs incurred by 75 pediatric patients managed by Fresh Start with 75 matched children in foster care. Compared to their matched controls, the average total expenditures of Fresh Start children were lower by $536 (p = .02, 95% CI [−1008, −63]), primary care expenditures were lower by $171 (p = .09, 95% CI [−371, 28]), and pharmacy expenditures were lower by $63 (p = .02, IQR = 598). Reduced expenditures identified among children managed by the Fresh Start PCMH may represent more access to care coordination, behavioral health services, and trauma-informed care, with more pronounced effects on primary care and pharmacy costs.

Out-of-Pocket Health Care Expenditures Among United States Children: Parental Perceptions and Past-Year Expenditures, 2016 to 2017.

To examine the association between parental perceptions of out-of-pocket (OOP) health care costs for their child and the total amount of OOP health care expenditures for that child during the past year. We used data from the 2016 and 2017 National Surveys of Children's Health, cross-sectional, parent-reported, and nationally representative surveys of noninstitutionalized US children, ages 0 to 17 years. We conducted bivariate analyses to assess characteristics associated with the amount of OOP expenditures and parental perceptions of these costs. We estimated adjusted prevalence ratios for parental perceptions of OOP costs using logistic regression. Based on parent report, nearly two thirds (65.7%) of children incurred some amount of past-year OOP expenditures, with 13.3% of children incurring expenditures of ≥$1000. Parents reported that costs were unreasonable for 35.3% of children with past-year expenditures. The amount of OOP spending was associated with parents' perceptions that costs were unreasonable, with 16.5% of those with $1 to 249 in expenditures reporting unreasonable costs compared to 77.5% of those with >$5,000 in expenditures (P < .05). In adjusted analyses, high OOP expenditures, non-Hispanic white race/ethnicity, lack of health insurance, low household income, parental education levels less than a college degree, and foreign-born nativity status were associated with reports of unreasonable costs (P < .05). This study demonstrates an association between attitudinal and economic measures of health care expenditures for children while demonstrating differences in the perception of costs by measures of family economic vulnerability. Results may inform efforts to assess adequacy of health insurance coverage.

286 Firearm Injuries: Long-Term Health Outcomes and Health Care Expenditures for Children

286 Firearm Injuries: Long-Term Health Outcomes and Health Care Expenditures for Children

Healthcare Expenditures for Autism During Times of School Transition: Some Vulnerable Families Fall Behind

This study explores the association between school transition age and healthcare expenditures for children with autism. The paper explores three questions: (1) What is the composition of services overall and paid out-of-pocket and does it differ at transition? (2) Do transition age children have higher total and out-of-pocket health care expenditures than other children with autism? (3) Does the effect of transition differ for vulnerable families who often experience problems accessing care? Pooled data from the Medical Expenditure Panel Survey 2000-2009 on children under 21 years of age with autism (n = 337) were used to describe expenditures for services by source of payment and estimate two-part models of total and out-of-pocket expenditures as a function of child transition age (5, 6, 11, 14) and other child and family characteristics. Median total annual expenditures for health care among children with autism are $2,400; median out-of-pocket expenditures are $390. The majority of total expenditures are devoted to outpatient medical services; nearly half of family out-of-pocket spending is devoted to prescription medications. When children are transition age, a larger proportion of both overall and out-of-pocket expenditures go toward ambulatory therapy, while a smaller proportion of out-of-pocket expenditures are devoted to prescription medications compared to children of other ages. Transition age children from vulnerable families experience a drop in expenditures that families with more resources fill through out-of-pocket spending. Findings raise questions about the dimensions of care for children with autism. Schools may be better positioned than health insurance to foster continuity of care.

A Primary Care Quality Improvement Approach to Health Care Transition

In the US, 18% of all youth have a special health care need. These needs represent 80% of all health care expenditures for children.1,2 Most of these youth will survive into adulthood as productive community members and will receive their health care in an adult model of care. To reach that goal, transition should be thought of as an active process over time that addresses many aspects of the youth’s life, including medical, psychosocial, educational, and vocational needs, as they prepare to move from childto adult-centered health care.3 Transfer should be thought of as the act of moving from one provider to another or from one location to another.4, 5 Thus, the transition process is twofold for

Health Care Use and Expenditures Associated With Access to the Medical Home for Children and Youth

The pediatric medical home is an approach to the delivery of family-centered health care. Policy-makers and payers are interested in potential changes to health care utilization and expenditures under this model. To test associations between having a medical home and health service use and expenditures among US children and youth. Observational cross-sectional study. A total of 26,221 children aged 0 to 17 years surveyed in the 2005 to 2007 Medical Expenditure Panel Surveys. Parent report of a child's access to a medical home was developed from multiple survey items in the Medical Expenditure Panel Surveys. Negative binomial regression examined the association between the medical home and parent-reported counts of annual outpatient, inpatient, emergency department, and dental visits. Two-part models examined associations between the medical home and parent-reported annual total, outpatient, inpatient, emergency department, and other health care expenditures. Models accounted for potential self-selection into a medical home using propensity scores. Children with a medical home had a greater incidence of preventive visits [incidence rate ratio (IRR)=1.11; (95% confidence intervals (CI), 1.03-1.20)] and dental visits [IRR=1.09 (95% CI, 1.02-1.17)] and a lower incidence of emergency department visits [IRR=0.87 (95% CI, 0.79-0.97)] compared with children without a medical home. Children with a medical home also had greater odds of incurring total, outpatient, prescription medication, and dental expenditures, OR's ranging from 1.09 to 1.38. Despite greater odds of incurring certain expenditures, expenditures were no different for children with and without a medical home. The medical home is associated with several domains of health service use, yet there is no evidence for its association with health care expenditures for children and youth.

Health Care Expenditures for Children With Autism Spectrum Disorders in Medicaid

Health Care Expenditures for Children With Autism Spectrum Disorders in Medicaid

Health Care Expenditures for Children With Autism Spectrum Disorders in Medicaid

To study trends in health care expenditures associated with autism spectrum disorders (ASDs) in state Medicaid programs. Using Medicaid data from 42 states from 2000 to 2003, patients aged 17 years and under who were continuously enrolled in fee-for-service Medicaid were studied. Patients with claims related to autistic disorder (autism) were identified, as were patients with claims for any ASD other than autism. Total expenditures per treated patient consisted of Medicaid reimbursements from inpatient, outpatient, and long-term care and prescription drugs. Inflation-adjusted expenditures were compared over time and with expenditures associated with other mental health disorders. A total of 2,184,677 children were diagnosed with some type of mental disorder during the study period. Of these children, 69,542 had an ASD, with 49,921 having autism and the rest having another ASD. Mean total health care expenditures per child with ASD were $22,079 in 2000 (in 2003 US dollars), and rose by 3.1% to $22,772 in 2003. The treated prevalence of autism per 10,000 covered lives rose by 32.2% from 40.6 to 53.6, the highest rate of increase among all mental disorders. Total health care expenditures for ASDs per 10,000 covered lives grew by 32.8% from $1,270,435 in 2000 (in 2003 dollars) to $1,686,938 in 2003. Medicaid-reimbursed health care expenditures for ASD were quite substantial. Although the per patient expenditures grew slightly over time, the large increase in treated prevalence caused a considerable rise in total ASD-associated health care expenditures.

Health services use and health care expenditures for children with disabilities.

To examine health care utilization and expenditure patterns for children with disabilities. Secondary data analysis was conducted of the 1999 and 2000 editions of the Medical Expenditure Panel Survey (MEPS), a nationally representative survey conducted in 5 rounds by household interview. Two years of MEPS data were combined in this analysis to improve the precision of estimates. Disability was defined by the presence of a limitation in age-appropriate social role activities, such as school or play, or receipt of specialized services through the early intervention or special education programs. The survey sample included 13,792 children younger than 18 years. The overall response rate was 65.5%. Our findings demonstrate that the 7.3% of US children with disabilities used many more services than their counterparts without disabilities in 1999-2000. The largest differences in utilization were for hospital days (464 vs 55 days per 1000), nonphysician professional visits (3.0 vs 0.6), and home health provider days (3.8 vs 0.04). As a result of their greater use, children with disabilities also had much higher health care expenditures (2669 dollars vs 676 dollars) and higher out-of-pocket expenditures (297 dollars vs 189 dollars). We also found that the distributions of total and out-of-pocket expenses were highly skewed, with a small fraction of the disabled population accounting for a large proportion of expenditures: the upper decile accounted for 65% of total health care expenses and 85% of all out-of-pocket expenses for the population with disabilities. Health insurance was found to convey significant protection against financially burdensome expenses. However, even after controlling for insurance status, low-income families experienced greater financial burdens than higher income families. The skewed distribution of out-of-pocket expenses found in this and earlier studies indicates that the financial burden of childhood disability continues to be shared unevenly by families. Low-income families are especially vulnerable to burdensome out-of-pocket expenses. Additional efforts are needed to protect these high-risk families.

Medical Care Use and Expenditures for Children across Stages of the Family Life Cycle

Past research has largely assumed that medical care use and expenditures for children are uniform across stages of family development. This study challenges that notion and investigates (a) differences in use of and expenditures for children's health services across stages of the family life cycle, and (b) the extent to which family characteristics affect medical care use and expenditures for children differently, depending on stage of the family life cycle. Data for the study are taken from the 1977 National Medical Care Expenditure Survey (NMCES). Stages of the family life cycle are identified on the basis of the age of the oldest child in the family. Family characteristics include family size, poverty status, number of parents, and mother's characteristics. The results show variation across stages of the family life cycle in terms of both children's mean number of physician visits and out-of-pocket health expenditures. Also, there were differences across certain stages in the effects of family size, single-parent status, mother's age, and mother's use of physician services on the number of children's physician visits. Mother's educational attainment and poverty status were found to have differential effects on out-of-pocket health care expenditures for children. The family is a social influence of considerable importance on the health and health behavior of children. Many have noted that the family plays a key role in the decision-making and therapeutic process at every stage of a child's illness (Litman, 1974). Medical sociologists and health services researchers have found that family characteristics play an important role in medical care use and expenditures for children. For example, family size shows a consistently strong relationship to use in that children from large families use fewer services than children from small families (Cafferata and Kasper, 1985; Kasper, 1975; Wolfe, 1980). Apparently, the time-cost of taking children to the doctor is higher in larger families, and children from small families benefit from more parental attention. Also, the presence of a spouse in a family appears to affect the health of children (Angel and Worobey, 1988) as well as their use of health services (Beck, 1974; Newacheck and Halfon, 1986a; Wilcox-Gok, 1983). Mothers are viewed as the gatekeepers to the health care system for children (Mechanic, 1964), and it can be expected that their characteristics and attitudes about health care play a prominent role in the decision to seek care for their children. Indeed, research has found that the employment status of mothers has an effect on the use of health services for their children (Cafferata and Kasper, 1985; Wolfe, 1980). Also, to the extent that employment increases a mother's NCHSR, 5600 Fisher's Lane, Room 18A55, Rockville, MD 20857.