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Health Care Utilization for Children in Foster Care
Colleen E Bennett1, Joanne N Wood2, Philip V Scribano3
1Division of General Pediatrics, The Children's Hospital of Philadelphia (CE Bennett, JN Wood, and PV Scribano), Philadelphia, Pa; National Clinician Scholars Program, University of Pennsylvania (CE Bennett), Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center (CE Bennett and JN Wood), Philadelphia, Pa.
Insights
Children in foster care (FC) have higher hospitalization and subspecialty care use. This increased healthcare utilization and associated costs in FC children are primarily driven by those with complex chronic conditions (CCCs).
Area of Science:
- Pediatric Health Services Research
- Health Economics
- Child Welfare and Healthcare
Background:
- Children in foster care (FC) often experience complex health needs.
- Understanding healthcare utilization patterns is crucial for this vulnerable population.
- Previous research has not fully elucidated the drivers of healthcare costs for FC children.
Purpose of the Study:
- To compare healthcare utilization and charges between children in foster care and a matched control group.
- To examine the prevalence of complex chronic conditions (CCCs) in FC children.
- To assess the impact of CCCs on healthcare utilization and costs for FC children.
Main Methods:
- Utilized electronic medical record (EMR) data from an urban pediatric health system.
- Matched 1156 FC cases with 4062 controls based on age, race/ethnicity, gender, and zip code.
- Employed mixed-effects models to analyze healthcare utilization rates (primary care, subspecialty, ED, hospitalizations) and charges over a one-year period.
Main Results:
- FC cases showed significantly higher rates of hospitalizations (18.5 vs 12.7 per 100 patient-years) and subspecialty visits (173.3 vs 113.6).
- FC cases incurred substantially higher overall charges ($14,372 vs $7082 per patient-year).
- Among children with CCCs, FC cases had higher utilization and charges; among those without CCCs, utilization and charges were similar.
Conclusions:
- Children in foster care utilize more hospitalizations and subspecialty care compared to matched controls.
- The elevated healthcare utilization and costs observed in FC children are predominantly attributable to those with complex chronic conditions.
- Targeted interventions for FC children with CCCs may be essential for managing healthcare resources effectively.
Objective:
To utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) health care utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and 3) prevalence of complex chronic conditions (CCC) and their effect on utilization.
Methods:
Children ≤18 years old with a designation of FC placement and controls matched on age, race/ethnicity, gender, and zip code who had an encounter at an urban pediatric health system between 7/1/11 and 6/30/12 were identified in the EMR. Data on outpatient, ED, and inpatient encounters and charges for 7/1/12 to 6/30/13 were obtained. A general linear mixed-effects model was applied to estimate means and rates for each group. Analyses were repeated among the subpopulations of children with and without CCCs.
Results:
A total of 1156 FC cases were matched to 4062 controls (mean = 3.5 controls/case). FC cases had significantly higher rates (per 100 patient-years) of hospitalizations (18.5 vs 12.7, P = .005), and subspecialty visits (173.3 vs 113.6; P < .001) but not ED (50.4 vs 45.2, P = .056) or primary care visits (154.6 vs 149.8; P = .50). FC cases had higher charges ($14,372 vs $7082; P < .001). Among children with CCCs, health care utilization rates and charges were higher among FC cases (all P < .001). Among children without CCC, rates and charges were similar for FC cases and controls (all P > .20).
Conclusions:
FC children utilized more hospitalizations and subspecialty office visits. The increased utilization rates and charges among children in FC were driven by the subset of children with CCCs.
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