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.
Children's Hospital Association (J Rodean and M Hall), Washington, DC.
Acad Pediatr. 2020 Jul;20(5):678-686. doi: 10.1016/j.acap.2020.01.013. Epub 2020 Feb 2.
To 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.
This 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.
Children 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.
Among 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.
研究具有典型支出和最高支出的任何心理健康 (MH) 诊断儿童的特征差异；确定最高支出的独立预测因素；并研究支出群体的驱动因素。
本回顾性分析利用来自 11 个州的 2016 年医疗补助数据，纳入了 775945 名年龄在 3 至 17 岁之间、至少有 11 个月连续覆盖的任何 MH 诊断儿童。我们根据总医疗保健支出比较了人口统计学特征和医疗补助支出：前 1%（最高支出）和其余 99%（典型支出）。我们使用卡方检验比较两组，使用调整后的逻辑回归识别进入前 1%最高支出组的独立预测因素。
MH 状况患者占 3 至 17 岁儿童医疗补助支出的 55%。最高支出组患者年龄更大、患有多种 MH 疾病且患有复杂的慢性身体健康状况（P <.001）。最高支出组的总医疗保健支出为每位成员每年 164003 美元（PMPY），而典型支出组为 6097 美元。门诊 MH 服务在典型支出组中支出占比最大（40%），为 2455 美元 PMPY；一般健康住院治疗在最高支出组中支出占比最大（36%），为 58363 美元 PMPY。
在 MH 状况患者中，精神和身体健康合并症很常见，一般医疗保健支出超过 MH 护理支出。未来的研究和质量倡议应重点关注整合 MH 和身体健康护理服务，并研究当前 MH 服务支出是否支持高质量的 MH 护理。
