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Healthcare utilization and expenditures for low income children with sickle cell disease
Jean L Raphael1, Craig L Dietrich, Deborah Whitmire
1Department of Pediatrics, Baylor College of Medicine, Academic General Pediatrics, Houston, Texas, USA. raphael@bcm.edu
Insights
Children with sickle cell disease (SCD) experience higher healthcare use, including hospitalizations and emergency care, compared to peers. Many children with SCD also have insufficient outpatient and specialty care visits.
Area of Science:
- Pediatric Health Services Research
- Hematology
- Public Health
Background:
- Limited research exists on the healthcare burden of sickle cell disease (SCD) in children, particularly concerning healthcare utilization and costs.
- Existing studies primarily focus on adult populations, leaving a gap in understanding pediatric SCD care needs.
Purpose of the Study:
- To characterize healthcare utilization and expenditures for low-income children with SCD.
- To compare healthcare use and costs in pediatric SCD patients against a control group of similar socioeconomic status.
Main Methods:
- Retrospective, cross-sectional analysis of administrative claims data from 2004-2007.
- Inclusion of children enrolled in Medicaid and State Children's Health Insurance Plan (SCHIP) within a managed care setting.
- Collection of data on patient demographics, insurance continuity, healthcare utilization, and expenditures for SCD and general populations.
Main Results:
- Children with SCD had significantly higher rates of inpatient hospitalization (27%) and emergency care utilization (39%) annually compared to the general population (P < 0.0001).
- A majority (63%) of children with SCD received one well-child check annually, while 10% had at least one annual outpatient visit to a hematologist.
Conclusions:
- Low-income children with SCD exhibit markedly higher healthcare utilization for inpatient, emergency, and home health services than their socio-demographically matched peers.
- A significant number of children with SCD may not meet recommended guidelines for outpatient primary care and comprehensive hematology care.
Background:
While multiple studies have examined the healthcare burden of sickle cell disease (SCD) in adults, few have specifically focused on healthcare utilization and expenditures in children. The objective of this study was to characterize the healthcare utilization and costs associated with the care of low-income children with SCD in comparison to other children of similar socioeconomic status.
Procedure:
For the study period, 2004-2007, we conducted a retrospective, cross-sectional descriptive analysis of administrative claims data from a managed care plan exclusively serving low-income children with Medicaid and the State Children's Health Insurance Plan (SCHIP). Patient demographics, continuity of insurance coverage, healthcare utilization, and expenditures were collected for all children enrolled with SCD and the general population within the health plan for comparison.
Results:
On average, 27% of members with SCD required inpatient hospitalization and 39% utilized emergency care in a given calendar year. Both values were significantly higher than those of the general health plan population (P < 0.0001). Across the study period, 63% of members with SCD averaged one well child check per year and 10% had a minimum of one outpatient visit per year to a hematologist for comprehensive specialty care.
Conclusions:
Low-income children with SCD demonstrate significantly higher healthcare utilization for inpatient care, emergency center care, and home health care compared to children with similar socio-demographic characteristics. A substantial proportion of children with SCD may fail to meet minimum guidelines for outpatient primary and hematology comprehensive care.
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