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Trends in Health Care Spending for Children in Medicaid With High Resource Use
Rishi Agrawal1,2, Matt Hall3, Eyal Cohen4
1Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; ragrawal@luriechildrens.org.
Insights
Most children with high Medicaid healthcare spending do not have persistently high costs. Adolescent age and multiple chronic conditions increase spending risk, while hospital and emergency department use decrease it.
Area of Science:
- Pediatric Health Services Research
- Health Economics
- Medicaid Policy
Background:
- High healthcare spending among children in Medicaid presents a significant challenge for resource allocation.
- Understanding the trends and characteristics of high-cost pediatric users is crucial for developing targeted interventions.
Purpose of the Study:
- To identify demographic, clinical, and health service factors associated with sustained high healthcare spending in children enrolled in Medicaid.
- To differentiate between transient, intermittent, and persistent high healthcare expenditure patterns.
Main Methods:
- Retrospective analysis of 48,743 children (ages 1-18) continuously enrolled in 10 state Medicaid programs from 2009-2013.
- Utilized multivariable regression to assess associations between baseline characteristics (2009-2010) and subsequent healthcare spending (2011-2013).
- Identified children in the top 5% of healthcare spending in 2010.
Main Results:
- High spending was transient for 54.2%, persistent for 32.9%, and intermittent for 12.9% of children.
- Older adolescents (13-18 years) had a higher likelihood of persistent spending compared to younger children (1-2 years).
- Having six or more chronic conditions, or specific complex conditions (respiratory, neuromuscular), significantly increased the odds of persistent high spending.
- Prior hospitalization and emergency department use were associated with a decreased likelihood of persistent high spending.
Conclusions:
- The majority of high-spending children in Medicaid do not exhibit persistently high costs over subsequent years.
- Factors like adolescent age, multiple chronic conditions, and specific complex conditions are key predictors of persistent high spending.
- These findings can inform the development of innovative care and financing models to optimize health outcomes and manage resources for high-need pediatric populations in Medicaid.
Objectives:
To assess characteristics associated with health care spending trends among child high resource users in Medicaid.
Methods:
This retrospective analysis included 48 743 children ages 1 to 18 years continuously enrolled from 2009-2013 in 10 state Medicaid programs (Truven MarketScan Medicaid Database) also in the top 5% of all health care spending in 2010. Using multivariable regression, associations were assessed between baseline demographic, clinical, and health services characteristics (using 2009-2010 data) with subsequent health care spending (ie, transiently, intermittently, persistently high) from 2011-2013.
Results:
High spending from 2011-2013 was transient for 54.2%, persistent for 32.9%, and intermittent for 12.9%. Regarding demographic characteristics, the highest likelihood of persistent versus transient spending occurred in children aged 13 to 18 years versus 1 to 2 years in 2010 (odds ratio [OR], 3.0 [95% confidence interval (CI), 2.7-3.4]). Regarding clinical characteristics, the highest likelihoods were in children with ≥6 chronic conditions (OR, 4.8 [95% CI, 3.5-6.6]), a respiratory complex chronic condition (OR, 2.5 [95% CI, 2.2-2.8]), or a neuromuscular complex chronic condition (OR, 2.3 [95% CI, 2.2-2.5]). Hospitalization and emergency department (ED) use in 2010 were associated with a decreased likelihood of persistent spending in 2011-2013 (hospitalization OR, 0.7 [95% CI, 0.7-0.7]); ED OR, 0.8 [95% CI, 0.8-0.8]).
Conclusions:
Most children with high spending in Medicaid are without persistently high spending in subsequent years. Adolescent age, multiple chronic conditions, and certain complex chronic conditions increased the likelihood of persistently high spending; hospital and ED use decreased it. These data may help inform the development of new models of care and financing to optimize health and save resources in children with high resource use.
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