Cassell Cynthia H, Grosse Scott D, Thorpe Phoebe G, Howell Eleanor E, Meyer Robert E
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Birth Defects Res A Clin Mol Teratol. 2011 Dec;91(12):1019-27. doi: 10.1002/bdra.22864. Epub 2011 Oct 22.
National data on health care use among children with special needs are limited and do not address children with spina bifida (SB). One recent study examined health care costs during 2003 among privately insured individuals with SB. Our objective was to compare health care use and expenditures among publicly insured children with SB to children without a major birth defect and among children with SB with and without hydrocephalus.
Data from the North Carolina Birth Defects Monitoring Program and Medicaid were linked to identify continuously enrolled children with SB (case children) and children without a major birth defect (control children) born from 1995 to 2002. Medicaid expenditures per child for medical, inpatient, outpatient, dental, well-child care, developmental/behavioral services, and home health for those aged 0 to 4 years old were calculated for case and control children and for case children with and without hydrocephalus.
Of 373 case children who survived infancy, 205 (55%) were enrolled in Medicaid. Expenditures were assessed for 144 case and 5674 control children aged 0 to 4 years old continuously enrolled in Medicaid. During infancy, mean expenditure was $33,135 per child with SB and $3900 per unaffected child. The biggest relative expenditures were for developmental/behavioral services (82 times higher for case than control child [$1401 vs. $17]) and home health services (20 times higher [$821 vs. $41]). Average expenditure for an infant with SB and hydrocephalus was 2.6 times higher than an infant with SB without hydrocephalus ($40,502 vs. $15,699).
Expenditure comparisons by SB subtype are important for targeting health care resources.
关于有特殊需求儿童的医疗保健使用情况的全国性数据有限，且未涉及脊柱裂（SB）患儿。最近的一项研究调查了2003年期间 privately insured 脊柱裂患者的医疗保健费用。我们的目标是比较公共保险的脊柱裂患儿与无重大出生缺陷儿童之间以及有和没有脑积水的脊柱裂患儿之间的医疗保健使用情况和支出。
将北卡罗来纳州出生缺陷监测项目和医疗补助的数据相链接，以识别1995年至2002年出生的持续参保的脊柱裂患儿（病例儿童）和无重大出生缺陷的儿童（对照儿童）。计算了0至4岁病例儿童和对照儿童以及有和没有脑积水的病例儿童在医疗、住院、门诊、牙科、健康儿童护理、发育/行为服务和家庭健康方面的人均医疗补助支出。
在373名度过婴儿期的病例儿童中，205名（55%）参加了医疗补助。对144名病例儿童和5674名0至4岁持续参加医疗补助的对照儿童的支出进行了评估。在婴儿期，脊柱裂患儿的人均支出为33,135美元，未受影响儿童为3900美元。相对支出最高的是发育/行为服务（病例儿童比对照儿童高82倍[1401美元对17美元]）和家庭健康服务（高20倍[821美元对41美元]）。患有脊柱裂和脑积水的婴儿的平均支出比没有脑积水的脊柱裂婴儿高2.6倍（40,502美元对15,699美元）。
按脊柱裂亚型进行支出比较对于确定医疗保健资源的目标很重要。
