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Health Care Use and Spending of Pediatric Patients With an Intellectual or Developmental Disability
Jaewhan Kim1, Paul Stevens2, Paul S Carbone3
1Departments of Physical Therapy, College of Health.
Insights
Children with intellectual or developmental disabilities (IDD) incur higher healthcare costs and utilization, particularly for home health and outpatient services. Emergency department use was similar between groups.
Area of Science:
- Pediatric Health Services Research
- Health Economics
- Disability Studies
Background:
- Individuals with intellectual or developmental disabilities (IDD) incur higher healthcare costs and utilization compared to the general population.
- Understanding specific service drivers is crucial for managing these disparities.
Purpose of the Study:
- To identify the healthcare services contributing to increased costs and utilization in non-institutionalized children with IDD.
- To compare healthcare spending and service use between children with and without IDD.
Main Methods:
- Secondary analysis of the 2000-2017 Medical Expenditure Panel Survey.
- Matched case-control study of pediatric patients (0-21 years) with and without IDD.
- Zero-inflated negative binomial regressions and generalized linear models were used to analyze utilization and costs.
Main Results:
- Children with IDD experienced significantly higher total healthcare spending ($5831 more) and more hospitalizations (IRR=1.63) than matched controls.
- Spending was higher across all categories except emergency department (ED) visits.
- Home health ($2558 more) and outpatient visits ($1180 more) showed the largest spending discrepancies.
Conclusions:
- Pediatric patients with IDD demonstrate elevated healthcare spending and utilization across most service categories compared to their non-IDD peers.
- ED utilization was comparable, but hospitalizations and overall costs were significantly higher for children with IDD.
Background:
Health care costs and utilization for those with an intellectual or developmental disability (IDD) have been shown to be higher than the general population.
Objective:
To investigate the services that contribute to higher costs and utilization among noninstitutionalized children with an IDD.
Design:
Matched case-control secondary analysis of the 2000-2017 Medical Expenditure Panel Survey. Pediatric (age 0-21) patients with an IDD were matched to non-IDD subjects. Health care utilization and costs were evaluated with zero-inflated negative binomial regressions and generalized linear models, respectively.
Measures:
Outcome measures included high-acuity health care utilization [ie, emergency department (ED) visits and hospital admissions], and cost outcomes for total spending, ED use, hospitalization, medications, office visits, home health, and physical therapy.
Results:
There was no statistical difference in utilization of EDs among the 2 groups though subjects with an IDD showed more hospitalizations than their matched cohort (incidence rate ratios=1.63, P=0.00). Total health care spending was higher among patients with an IDD (coefficient=$5831, P=0.00). Pediatric spending was higher in all measures except for ED. The biggest discrepancies in spending were seen in home health (coefficient=$2558, P=0.00) and outpatient visits (coefficient=$1180, P=0.00).
Conclusions:
Pediatric patients with an IDD had higher health care spending and utilization than non-IDD subjects in all categories except for ED use.
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