Bui Anthony L, Dieleman Joseph L, Hamavid Hannah, Birger Maxwell, Chapin Abigail, Duber Herbert C, Horst Cody, Reynolds Alex, Squires Ellen, Chung Paul J, Murray Christopher J L
David Geffen School of Medicine at UCLA, University of California, Los Angeles.
Institute for Health Metrics and Evaluation, Seattle, Washington.
JAMA Pediatr. 2017 Feb 1;171(2):181-189. doi: 10.1001/jamapediatrics.2016.4086.
Health care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time.
To provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care.
Health care spending estimates were extracted from the Institute for Health Metrics and Evaluation Disease Expenditure 2013 project database. This project, based on 183 sources of data and 2.9 billion patient records, disaggregated health care spending in the United States by condition, age and sex group, and type of care. Annual estimates were produced for each year from 1996 through 2013. Estimates were adjusted for the presence of comorbidities and are reported using inflation-adjusted 2015 US dollars.
From 1996 to 2013, health care spending on children increased from $149.6 (uncertainty interval [UI], 144.1-155.5) billion to $233.5 (UI, 226.9-239.8) billion. In 2013, the largest health condition leading to health care spending for children was well-newborn care in the inpatient setting. Attention-deficit/hyperactivity disorder and well-dental care (including dental check-ups and orthodontia) were the second and third largest conditions, respectively. Spending per child was greatest for infants younger than 1 year, at $11 741 (UI, 10 799-12 765) in 2013. Across time, health care spending per child increased from $1915 (UI, 1845-1991) in 1996 to $2777 (UI, 2698-2851) in 2013. The greatest areas of growth in spending in absolute terms were ambulatory care among all types of care and inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma among all conditions.
These findings provide health policy makers and health care professionals with evidence to help guide future spending. Some conditions, such as attention-deficit/hyperactivity disorder and inpatient well-newborn care, had larger health care spending growth rates than other conditions.
美国儿童医疗保健支出持续上升，但对于这种支出如何因疾病、年龄和性别组以及护理类型而异，以及这些模式随时间如何变化，人们知之甚少。
提供1996年至2013年美国19岁及以下儿童和青少年的医疗保健支出估计，按疾病、年龄和性别组以及护理类型进行分类。
医疗保健支出估计数取自健康指标与评估研究所2013年疾病支出项目数据库。该项目基于183个数据来源和29亿条患者记录，按疾病、年龄和性别组以及护理类型对美国的医疗保健支出进行了分类。对1996年至2013年的每一年都进行了年度估计。估计数针对合并症的存在进行了调整，并以2015年经通胀调整的美元报告。
1996年至2013年，儿童医疗保健支出从1496亿美元（不确定区间[UI]，1441 - 1555亿美元）增至2335亿美元（UI，2269 - 2398亿美元）。2013年，导致儿童医疗保健支出的最大健康状况是住院环境中的健康新生儿护理。注意力缺陷/多动障碍和健康牙科护理（包括牙齿检查和正畸）分别是第二和第三大支出状况。2013年，1岁以下婴儿的人均支出最高，为11741美元（UI，10799 - 12765美元）。随着时间推移，儿童人均医疗保健支出从1996年的1915美元（UI，1845 - 1991美元）增至2013年的2777美元（UI，2698 - 2851美元）。绝对支出增长最大的领域是各类护理中的门诊护理以及住院健康新生儿护理、注意力缺陷/多动障碍和所有疾病中的哮喘。
这些发现为卫生政策制定者和医疗保健专业人员提供了有助于指导未来支出的证据。一些状况，如注意力缺陷/多动障碍和住院健康新生儿护理，其医疗保健支出增长率高于其他状况。
