Utilization under children's health insurance programs: children with vs. without chronic conditions

Area of Science:

• Health Services Research
• Pediatric Health Economics
• Public Health Policy

Background:

• States require data to project healthcare utilization for children's insurance programs.
• Understanding cost variations is essential for effective program planning and budgeting.

Purpose of the Study:

• To estimate the cost of a comprehensive health insurance benefit package for children.
• To analyze cost differences based on health status (chronic vs. no chronic condition).

Main Methods:

• Analysis of children's health insurance program data from Pennsylvania.
• Estimation of average costs for continuously enrolled children during 1994-1995.

Main Results:

• The average annual cost for a continuously enrolled child was approximately $500.
• Children with chronic conditions incurred significantly higher costs ($1,208) compared to those without ($454).
• Costs varied widely across different types of services.

Conclusions:

• The estimated costs may underestimate expenses for new programs due to exclusion of very sick children and lower average costs for continuously enrolled individuals.
• Accurate cost projections require consideration of enrollment dynamics and the full spectrum of child health needs.