Health Care Utilization and Spending for Children With Mental Health Conditions in Medicaid |
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| Affiliation: | 1. Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children''s Hospital of Philadelphia, The Leonard Davis Institute of Health Economics, The University of Pennsylvania (SK Doupnik), Philadelphia, Pa;2. Children''s Hospital Association (J Rodean and M Hall), Washington, DC;3. Department of Pediatrics, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Children''s Hospital Colorado, University of Colorado School of Medicine (J Feinstein), Aurora, Colo;4. Department of Pediatrics, Monroe Carell Children''s Hospital at Vanderbilt, Vanderbilt University School of Medicine (JC Gay), Nashville, Tenn;5. Department of Pediatrics, Children''s Mercy Kansas City, University of Missouri-Kansas City School of Medicine (J Simmons, JL Bettenhausen, and JL Markham), Kansas City, Mo;6. Department of Psychiatry and Biobehavioral Sciences, UCLA-Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (BT Zima);7. Division of General Pediatrics, Department of Medicine, Complex Care Service, Boston Children''s Hospital, Harvard Medical School (JG Berry), Boston, Mass;1. Division of Pediatric Endocrinology, Department of Pediatrics (M Cree-Green), University of Colorado Anschutz Medical Campus, Aurora, Colo;2. Department of Family Medicine (M Cree-Green), Idaho State University, Pocatello, Idaho;3. Department of Pediatrics (J Cree), University of Colorado Anschutz Medical Campus, Aurora, Colo;4. Department of Pediatric (K Urban and M Bunik), University of Colorado Anschutz Medical Campus, Aurora, Colo;5. Division of Adolescent Medicine, Department of Pediatrics (AE Sass), University of Colorado Anschutz Medical Campus, Aurora, Colo;6. Division of Neonatology, Department of Pediatrics (A Rosenberg), University of Colorado Anschutz Medical Campus, Aurora, Colo;1. Department of Pediatrics, University of Rochester Medical Center (A-M Conn), Rochester, NY;2. Department of Pediatrics, University of California at Los Angeles (UCLA) (M Szilagyi);3. Child Protection Program and Foster Children Evaluation Services and UMASS Children''s Medical Center, University of Massachusetts Medical School (H Forkey), Worchester, Mass;1. Department of Pediatrics (DJ Opel), University of Washington School of Medicine, and Seattle Children''s Research Institute, Seattle, Wash;2. Kaiser Permanente Washington Health Research Institute (NB Henrikson), Seattle, Wash;3. Yale School of Nursing (K Lepere), Orange, Conn;4. Department of Communication (JD Robinson), Portland State University, Portland, Ore;1. Department of Pediatrics (DM D''Alessandro), University of Iowa, Iowa City, Iowa;2. Department of Pediatrics (MS Ryan), Virginia Commonwealth University School of Medicine, Va;3. Department of Pediatrics (S Paik), Columbia University College of Physicians and Surgeons, New York, NY;4. Department of Pediatrics (TL Turner), Baylor College of Medicine, Texas Children''s Hospital, Friendswood, Tex;5. Department of Pediatrics (J Huber), University of South Dakota Sanford School of Medicine, Sioux Falls, SD;6. Department of Pediatrics (NM Potisek), Wake Forest School of Medicine, Winston-Salem, NC;7. Department of Pediatrics (HB Fromme), University of Chicago Pritzker School of Medicine, Chicago, Ill;1. Department of Pediatrics, Johns Hopkins University School of Medicine, (KK Upadhya, KJ Psoter, KA Connor, KB Mistry, DJ Levy, and TL Cheng), Baltimore, Md;2. Division of Adolescent and Young Adult Medicine, Children''s National Medical Center, (KK Upadhya), Washington, DC;3. Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, (TL Cheng), Baltimore, Md;4. Office of Extramural Research, Education and Priority Populations, Agency for Healthcare Research and Quality, (KB Mistry), Rockville, Md;5. Child and Teen Wellness Center, (DJ Levy), Owings Mills, Md;1. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Mass |
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| Abstract: | ObjectiveTo examine how characteristics vary between children with any mental health (MH) diagnosis who have typical spending and the highest spending; to identify independent predictors of highest spending; and to examine drivers of spending groups.MethodsThis retrospective analysis utilized 2016 Medicaid claims from 11 states and included 775,945 children ages 3 to 17 years with any MH diagnosis and at least 11 months of continuous coverage. We compared demographic characteristics and Medicaid expenditures based on total health care spending: the top 1% (highest-spending) and remaining 99% (typical-spending). We used chi-squared tests to compare the 2 groups and adjusted logistic regression to identify independent predictors of being in the top 1% highest-spending group.ResultsChildren with MH conditions accounted for 55% of Medicaid spending among 3- to 17-year olds. Patients in the highest-spending group were more likely to be older, have multiple MH conditions, and have complex chronic physical health conditions (P <.001). The highest-spending group had $164,003 per-member-per-year (PMPY) in total health care spending, compared to $6097 PMPY in the typical-spending group. Ambulatory MH services contributed the largest proportion (40%) of expenditures ($2455 PMPY) in the typical-spending group; general health hospitalizations contributed the largest proportion (36%) of expenditures ($58,363 PMPY) in the highest-spending group.ConclusionsAmong children with MH conditions, mental and physical health comorbidities were common and spending for general health care outpaced spending for MH care. Future research and quality initiatives should focus on integrating MH and physical health care services and investigate whether current spending on MH services supports high-quality MH care. |
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