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Healthcare utilization and spending by children with cancer on Medicaid
Emily L Mueller1,2, Matt Hall3, Jay G Berry4
1Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana.
Insights
Children with cancer utilize significant healthcare resources and incur high spending. Further research into service distribution and spending trends can optimize care costs for pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Health Services Research
- Healthcare Economics
Background:
- Children with cancer represent a unique group with complex, high-resource healthcare needs.
- Understanding their healthcare utilization is key to optimizing care delivery and resource allocation.
Purpose of the Study:
- To analyze the clinical attributes, healthcare utilization, and spending patterns of children with cancer enrolled in Medicaid.
- To identify key areas of high resource use and associated costs in this pediatric population.
Main Methods:
- Retrospective, cross-sectional analysis of the 2014 Truven Marketscan Medicaid Database.
- Inclusion of children aged 0-18 years with a cancer diagnosis (Clinical Risk Group 8).
- Assessment of healthcare utilization and per member per month (PMPM) spending across various services.
Main Results:
- Children with cancer (n=5,405) comprised <1% of children with medical complexity in the dataset.
- High utilization rates observed for laboratory/radiographic testing (93.0%), outpatient specialty care (83.4%), and hospitalization (31.5%).
- Overall PMPM spending was $3,706, with $2,323 attributed to hospital care.
Conclusions:
- Children with cancer demonstrate substantial healthcare resource utilization and high associated costs.
- Future research should investigate geographic service distribution and spending trajectories to reduce costs without impacting outcomes.
Background:
Children with cancer are a unique patient population with high resource, complex healthcare needs. Understanding their healthcare utilization could highlight areas for care optimization.
Procedure:
We performed a retrospective, cross-sectional analysis of the 2014 Truven Marketscan Medicaid Database to explore clinical attributes, utilization, and spending among children with cancer who were Medicaid enrollees. Eligible patients included children (ages 0-18 years) with cancer (Clinical Risk Group 8). Healthcare utilization and spending (per member per month, PMPM) were assessed overall and across specific healthcare services.
Results:
Children with cancer (n = 5,405) represent less than 1% of the 1,516,457 children with medical complexity in the dataset. Children with cancer had high services use: laboratory/radiographic testing (93.0%), outpatient specialty care (83.4%), outpatient therapy/treatment (53.4%), emergency department (43.7%), hospitalization (31.5%), home healthcare (9.5%). PMPM spending for children with cancer was $3,706 overall and $2,323 for hospital care.
Conclusion:
Children with cancer have high healthcare resource use and spending. Differences in geographic distribution of services for children with cancer and the trajectory of spending over the course of therapy are areas for future investigation aimed at lowering costs of care without compromising on health outcomes.