华盛顿州一项健康计划中按健康状况分组和严重程度划分的儿童医疗费用概况。
Profile of medical charges for children by health status group and severity level in a Washington State Health Plan.
作者信息
Neff John M, Sharp Virginia L, Muldoon John, Graham Jeff, Myers Kristin
机构信息
Center for Children with Special Needs, Children's Hospital and Regional Medical Center, Seattle, WA, USA.
出版信息
Health Serv Res. 2004 Feb;39(1):73-89. doi: 10.1111/j.1475-6773.2004.00216.x.
OBJECTIVE
To identify children and evaluate patterns of charges for pediatric medical care, by overall health status, severity of illness, and categories of medical service. Data Sources Enrollment, claims, and charges data from a Washington State health plan. The study population includes all children ages 0 to 18 years during calendar year 1999.
STUDY DESIGN
Children were classified into clinically defined health status groups and severity levels using Clinical Risk Groups (CRGs). Health plan charges were analyzed according to core health status group, severity level, and category of service.
DATA COLLECTION
The three secondary data sources were obtained electronically from the health plan and cleaned for unique members and data quality before analysis.
PRINCIPAL FINDINGS
Children classified as healthy (85.2 percent) had mean and median annual charges of dollar 485 and dollar 191. Children with one or more chronic conditions (9.5 percent) had mean and median charges increasing by status and severity group from dollar 2,303 to dollar 76,143 and from dollar 1,151 to dollar 19,456, and accounted for 45.2 percent of all charges. Distribution of charges varied across health status groups. Healthy children had 70.6 percent of their charges in outpatient and physician services. Children classified in the complex, catastrophic, and malignancy groups had 67 percent of their charges in inpatient encounters. Children with chronic conditions accounted for 31.8 percent of all physician, 41.8 percent of outpatient, 47.7 percent of pharmacy, 60.7 percent of inpatient, and 75.8 percent of all other charges.
CONCLUSIONS
Children with chronic conditions account for a disproportionately high percentage of children's health expenditures. They account for different percentages of expenses for different medical services. These percentages vary according to health status and severity. This analysis can be used to identify and track groups of children for various purposes.
目的
根据总体健康状况、疾病严重程度和医疗服务类别，识别儿童并评估儿科医疗费用模式。数据来源华盛顿州一项健康计划的参保、理赔和费用数据。研究人群包括1999年日历年所有0至18岁的儿童。
研究设计
使用临床风险组（CRG）将儿童分为临床定义的健康状况组和严重程度级别。根据核心健康状况组、严重程度级别和服务类别分析健康计划费用。
数据收集
从健康计划以电子方式获取这三个二手数据源，并在分析前针对唯一成员和数据质量进行清理。
主要发现
被归类为健康的儿童（85.2%）年均费用均值和中位数分别为485美元和191美元。患有一种或多种慢性病的儿童（9.5%），其费用均值和中位数按状况和严重程度组从2303美元增至76143美元，从1151美元增至19456美元，占所有费用的45.2%。费用分布在不同健康状况组中有所不同。健康儿童70.6%的费用用于门诊和医生服务。归类为复杂、灾难性和恶性肿瘤组的儿童67%的费用用于住院治疗。患有慢性病的儿童占所有医生费用的31.8%、门诊费用的41.8%、药房费用的47.7%、住院费用的60.7%以及所有其他费用的75.8%。
结论
患有慢性病的儿童在儿童健康支出中所占比例过高。他们在不同医疗服务费用中所占比例不同。这些比例因健康状况和严重程度而异。该分析可用于出于各种目的识别和跟踪儿童群体。
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