Health care utilization and spending among privately insured children with medical complexity

Area of Science:

• Health Services Research
• Health Economics
• Pediatric Health

Background:

• Children with medical complexity (CMC) exhibit high healthcare utilization and associated costs.
• These expenditures can create substantial financial strain for families.
• Understanding these financial burdens within private health plans is crucial.

Purpose of the Study:

• To analyze healthcare utilization and spending differences for children in US private health plans.
• To compare financial burdens across different health plan types and levels of medical complexity.
• To identify factors contributing to out-of-pocket spending for pediatric medical care.

Main Methods:

• Utilized IBM Watson/Truven Analytics MarketScan data (2012-2014).
• Employed regression models to analyze healthcare utilization and spending.
• Disaggregated data by health plan type and children's medical complexity levels.

Main Results:

• Children in consumer-driven and high-deductible plans incurred higher out-of-pocket spending than those in HMOs/PPOs.
• CMC experienced greater service utilization and out-of-pocket costs, with lower cost shares.
• Families with high-deductible or consumer-driven plans were significantly more likely to exceed $1000 in out-of-pocket costs.

Conclusions:

• Children's medical complexity and health plan design significantly impact family finances.
• Demand-side cost-sharing in health plans exacerbates financial burdens for families with CMC.
• Policymakers and families must address the financial implications of pediatric healthcare needs and plan structures.