Sices Laura, Harman Jeffrey S, Kelleher Kelly J
Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.
Public Health Rep. 2007 Jul-Aug;122(4):531-40. doi: 10.1177/003335490712200415.
Children with special health-care needs are an important group for policy and research planning. Special education engages a group of children with increased utilization of services related to education. While increased service utilization in education or health-care settings is often used to classify children as having special needs, considerable heterogeneity exists within each group. The extent to which being identified in two functionally defined systems--special education and health care--relates to health-care utilization is unknown. We sought to determine health-care and mental health utilization and expenditures for children dually classified as receiving special education and having special health-care needs (SHCN) compared with those who only have SHCN, only are in special education, or don't fall into either category.
A nationally representative sample of children aged 5-17 years from the Medical Expenditure Panel Survey was used to compare mean health-care and mental health utilization and expenditures for the four groups.
Dually classified children had significantly higher mean utilization of health-care services than the other three groups (p < 0.05). Mean 12-month total health-care expenditures were highest for dually classified children ($3,891/year) (p < 0.05) and higher for children classified only as having SHCN ($1,426/year) than for children with neither classification ($644/year, p < 0.05).
Children dually classified as receiving special education and having SHCN represent a subgroup of children with SHCN with high levels of health-care utilization and expenditures. This information can assist policy makers in identifying characteristics that place children at risk for very high expenditures, and in allocating health-care resources.
有特殊医疗需求的儿童是政策和研究规划的重要群体。特殊教育涉及一群服务利用增加的儿童，这些服务与教育相关。虽然教育或医疗环境中服务利用的增加通常被用来将儿童归类为有特殊需求，但每组中都存在相当大的异质性。在两个功能定义的系统——特殊教育和医疗保健——中被认定与医疗保健利用之间的关联程度尚不清楚。我们试图确定与仅患有特殊医疗需求（SHCN）、仅接受特殊教育或不属于这两类的儿童相比，双重分类为接受特殊教育且有特殊医疗需求（SHCN）的儿童的医疗保健和心理健康利用情况及支出。
使用来自医疗支出小组调查的5至17岁儿童的全国代表性样本，比较这四组儿童的平均医疗保健和心理健康利用情况及支出。
双重分类的儿童的医疗保健服务平均利用率显著高于其他三组（p < 0.05）。双重分类儿童的12个月总医疗保健支出均值最高（每年3891美元）（p < 0.05），仅被归类为患有SHCN的儿童（每年1426美元）的支出高于未被归类的儿童（每年644美元，p < 0.05）。
双重分类为接受特殊教育且患有SHCN的儿童代表了患有SHCN且医疗保健利用率和支出水平较高的儿童亚组。这些信息可以帮助政策制定者识别使儿童面临高支出风险的特征，并分配医疗保健资源。
