Takayama J I, Bergman A B, Connell F A
Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle.
JAMA. 1994 Jun 15;271(23):1850-5.
To determine and compare health care utilization and expenditures of children in foster care with those of other children and to identify and describe high-cost children in foster care.
Analysis of the Medicaid program claims data in the state of Washington.
A total of 1631 children in foster care and 5316 children in the Aid to Families With Dependent Children (AFDC) program in 1990. The children were ages 0 through 7 years and eligible for Medicaid continuously during the study year.
Health care utilization and expenditures classified by types of health service and health care provider; proportion of children with 1990 expenditures exceeding $10,000 and most prominent diagnoses associated with their health care utilization.
Mental health services were used by 25% of children in foster care compared with 3% of AFDC children (P < .001), and supportive services of visiting nurses and physical therapists were used by 13% of children in foster care and 1% of AFDC children (P < .001). Twice as many children in foster care than AFDC children used medical equipment or specialist services or were hospitalized (P < .001). Mean health care expenditures in 1990 were $3075 for children in foster care and $543 for AFDC children (P < .001). High-cost children included 8% of children in foster care and 0.4% of AFDC children. Among the high-cost children in foster care (n = 106), 59% had mental disorders and 31% had congenital conditions.
Results suggest a higher prevalence and greater complexity of illnesses, particularly mental disorders, among children in foster care. Despite the high utilization and cost of mental health services, previous research suggests there may be underutilization of these services compared with need. Appropriate allocation of resources is essential if foster care agencies are to adequately meet the diverse and compelling needs of children in foster care.
确定并比较寄养儿童与其他儿童的医疗保健利用情况及支出，并识别和描述寄养儿童中的高成本儿童。
对华盛顿州医疗补助计划的索赔数据进行分析。
1990年共有1631名寄养儿童和5316名领取抚养儿童家庭补助（AFDC）计划的儿童。这些儿童年龄在0至7岁之间，在研究年度内持续符合医疗补助资格。
按医疗服务类型和医疗保健提供者分类的医疗保健利用情况及支出；1990年支出超过10,000美元的儿童比例以及与其医疗保健利用相关的最突出诊断。
25%的寄养儿童使用心理健康服务，而AFDC儿童中这一比例为3%（P <.001）；13%的寄养儿童使用访视护士和物理治疗师的支持性服务，AFDC儿童中这一比例为1%（P <.001）。使用医疗设备或专科服务或住院的寄养儿童数量是AFDC儿童的两倍（P <.001）。1990年寄养儿童的平均医疗保健支出为3075美元，AFDC儿童为543美元（P <.001）。高成本儿童在寄养儿童中占8%，在AFDC儿童中占0.4%。在寄养儿童中的高成本儿童（n = 106）中，59%患有精神障碍，31%患有先天性疾病。
结果表明，寄养儿童中疾病的患病率更高且病情更复杂，尤其是精神障碍。尽管心理健康服务的利用率和成本很高，但先前的研究表明，与需求相比，这些服务可能未得到充分利用。如果寄养机构要充分满足寄养儿童的各种迫切需求，合理分配资源至关重要。
