The COVID-19 pandemic is an unprecedented global crisis, affecting millions globally and in Canada. While efforts to limit the spread of the infection and ‘flatten the curve’ may buffer children and youth from acute illness, these public health measures may worsen existing inequities for those living on the margins of society. In this commentary, we highlight current and potential long-term impacts of COVID-19 on children and youth centring on the UN Convention of the Rights of the Child (UNCRC), with special attention to the accumulated toxic stress for those in difficult social circumstances. By taking responsive action, providers can promote optimal child and youth health and well-being, now and in the future, through adopting social history screening, flexible care models, a child/youth-centred approach to “essential” services, and continual advocacy for the rights of children and youth.
Boston Children's Hospital.Purpose: New accountable care payment models are focusing on reducing total medical expense (TME) for a patient population. Health care providers are incentivized to reduce costs. Our objective was to characterize TME for average cost adolescents and elucidate the causes of high TME in order to identify opportunities for prevention, case management, and potentially cost savings. Methods: We analyzed de-identified data from 13,439 adolescent patients in a large private insurance database from January 1, 2012 to December 31, 2012. Data were obtained from primary care patients in a large practice association affiliated with an academic medical center. Results: Patients ranged in age from 12 to 21 years old (median 17 years), with 50% males (N ¼ 6725) and 50% females (N ¼ 6714).The median annual total medical expense (TME) for an adolescent patient in this cohort was $1,117, compared to average annual TME for privately insured patients of all ages in Massachusetts of $4,968 in 2010. A small fraction of patients (2.1%, N ¼ 287) with annual TME greater than $20,000 accounted for a large proportion (32%) of annual expenses of $41,781,922 for this entire cohort. The median age for high cost patients was 17, and there were similar numbers of male (N ¼ 150) and female patients (N ¼ 137). Being a high cost patient was associated with a higher likelihood of having a behavioral health condition such as depression, anxiety, or attention deficit disorder (61% vs. 30%, p < 0.001). Certain extremely high cost patients (0.1%, N ¼ 25), with annual expenses greater than $100,000 accounted for 8% of the cohort's TME. The greatest contributor to extremely high annual medical expense for these patients was inpatient hospitalization. Diagnoses among extremely high cost patients included traumatic injuries, congenital anomalies, diabetes, and behavioral conditions. Three out of the top 25 extremely high cost patients were receiving care for eating disorders. Conclusions: A small number of adolescent patients accounted for a disproportionate amount of annual medical expense in this population. Our findings suggest that strategies for intervention and cost reduction in this group should include case management and integrated behavioral and medical services.
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