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Rate of spending on chronic conditions among Medicaid and CHIP recipients
Rishi Agrawal1, Tracie Smith2, Yan Li2
1Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; andLa Rabida Children's Hospital, Chicago, Illinois ragrawal@luriechildrens.org.
Insights
During an economic recession, more children with chronic conditions enrolled in Medicaid and the Children's Health Insurance Program (CHIP). Spending decreased overall, but enrollment of complex cases rose, driving total cost increases.
Area of Science:
- Health Services Research
- Pediatric Health Economics
- Public Health Policy
Background:
- Economic recessions can impact healthcare access and utilization for vulnerable populations.
- Understanding healthcare enrollment trends among children with chronic conditions is crucial for resource allocation.
- Medicaid and the Children's Health Insurance Program (CHIP) are vital safety nets for pediatric healthcare.
Purpose of the Study:
- To assess the enrollment rates of children with and without chronic conditions in Medicaid and CHIP during an economic recession.
- To analyze changes in healthcare spending and service utilization among children with chronic conditions during this period.
Main Methods:
- Utilized Illinois fee-for-service Medicaid and CHIP data from 2007-2010.
- Employed 3M Clinical Risk Group software to categorize children into five chronic condition groups.
- Measured changes in recipient numbers, total and per capita spending by service category, and service utilization.
Main Results:
- Children with chronic conditions enrolled in Medicaid/CHIP at a higher rate (26.7%) than those without (14.5%) between 2007-2010.
- Inflation-adjusted mean spending decreased across most chronic condition categories, except malignancy.
- Inpatient and emergency department utilization declined, while outpatient utilization increased for children with chronic conditions.
Conclusions:
- A disproportionately higher number of children with chronic conditions became Illinois Medicaid and CHIP recipients during the 2007-2010 economic recession.
- Increased total healthcare spending was attributed to a rise in recipients with complex conditions, not increased per-member costs.
Objective:
To evaluate the rate at which children with and without chronic conditions became recipients of Medicaid and the Children's Health Insurance Program (CHIP) during a period of economic recession and to evaluate changes in spending and service utilization among children with chronic conditions.
Methods:
Child recipients of Illinois fee-for-service Medicaid and CHIP from 2007 to 2010 were assigned to 5 chronic condition groups using 3M Clinical Risk Group software. Outcome measures were change in recipient number in each chronic condition category, total and per capita spending changes within various categories of service, and changes in service utilization.
Results:
From 2007 to 2010, children with chronic conditions became recipients of Illinois fee-for-service Medicaid and CHIP at a higher rate than children without chronic conditions (26.7% vs 14.5%). Inflation-adjusted mean spending fell with a linear trend in all chronic condition categories except malignancy (P < .001). Per member inpatient and emergency department service utilization fell and outpatient service utilization increased in all condition categories. Average inpatient length of stay declined in all chronic condition groups (P < .001) but not in children without chronic conditions.
Conclusions:
From 2007 to 2010, a period of severe economic recession, a disproportionately high number of children with chronic conditions became Illinois Medicaid and CHIP recipients. Total spending increases were driven by an increase in the number of recipients with the most complex chronic conditions, not increases in per-member spending.
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