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Health care utilization and expenditures associated with child care attendance: a nationally representative sample
Michael Silverstein1, Anne E Sales, Thomas D Koepsell
1Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle, Washington 98195, USA. msilve@u.washington.edu
Insights
Children in center-based child care utilize more health care services, leading to modest increases in per-child expenditures. This is likely due to a higher incidence of communicable illnesses in these settings.
Area of Science:
- Pediatric Health
- Health Services Research
- Epidemiology
Background:
- Center-based child care is linked to increased communicable illnesses in preschoolers.
- Nationally representative US data on child care-related health care utilization and costs are limited.
Purpose of the Study:
- To determine health care utilization and cost patterns associated with different types of child care in a nationally representative US sample of preschool-aged children.
Main Methods:
- Analysis of a nationally representative sample (N=871) of children aged 0-5 years from the 1997 Medical Expenditure Panel Survey.
- Cross-sectional analysis using a 2-part multivariate regression model to analyze skewed expenditure data.
Main Results:
- Children in center-based child care had higher odds of office visits (aOR: 2.8), emergency department visits (aOR: 2.0), and medication prescriptions (aOR: 2.8) compared to those not in child care.
- Predicted annual health care expenditures were $985 for children in center-based care versus $642 for those not in child care.
- Trends in office visits and prescriptions mirrored overall expenditure differences.
Conclusions:
- Children in center-based child care experience higher immediate health care utilization and costs.
- This increased utilization is likely driven by a greater incidence of minor, self-limited communicable illnesses.
- Findings highlight the economic impact of child care settings on pediatric health care spending.
Objective:
Participation in center-based child care among preschool-aged children is associated with an increased incidence of communicable illness. Although estimates of health care utilization and costs associated with child care attendance exist in other countries with different health care systems, nationally representative data for the United States are lacking. The objective of this study was to determine the patterns of health care utilization and costs associated with attendance at different types of child care, among a nationally representative sample of preschool-aged children.
Methods:
A nationally representative sample of children aged 0 to 5 years enrolled in the Medical Expenditure Panel Survey, 1997 Cohort were studied. Data were analyzed by cross-sectional analysis within a single calendar year. The Rand Health Insurance experiment 2-part multivariate regression model was used to accommodate skewed expenditure data.
Results:
A total of 871 children were included in the study. A total of 484 (56%) attended no child care provided by anyone other than their primary caregiver; 134 (15%) attended center-based child care; 76 (9%) attended friend or neighbor care; and 170 (20%) attended in-home or relative care. In a weighted multivariate model, children in center-based child care were more likely than those not in child care to have attended at least 1 office-based visit (adjusted odds ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.0-7.9) and emergency department visit (aOR: 2.0; 95% CI: 1.1-3.6) and to have received a medication prescription (aOR: 2.8; 95% CI: 1.2-6.1). The adjusted 2-part model predicted total health care expenditures for those not attending child care to be 642 dollars (95% CI: 508-813), versus 985 dollars (95% CI: 714-1336) for a similar population in center-based child care. Expenditure data for office-based visits and medication prescriptions mirrored these trends.
Conclusion:
In the immediate term, children in center-based child care tend to use more health care services. This increased utilization translates into modest per-child differences in health care expenditures. We hypothesize that this pattern of utilization and expenditure is attributable primarily to a higher incidence of minor, self-limited, communicable illness among children in center-based child care.