Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance

Kuo, Dennis Z.; Hall, Matt; Agrawal, Rishi; Cohen, Eyal; Feudtner, Chris; Goodman, Denise M.; Neff, John M.; Berry, Jay G.

doi:10.1542/peds.2015-0871

Cited by 56 publications

(63 citation statements)

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“…11 Following the work of Kuo et al, a standard payment per unit of service was generated from the fee-for-service payments, and then multiplied by the number of units on a claim to compute a claim total. 12 This was applied to both managed care and fee-for-service claims.…”

Section: Methodsmentioning

confidence: 99%

Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population

et al. 2016

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Section: Methodsmentioning

confidence: 99%

Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population

et al. 2016

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“…3–9 Moreover, few have split spending across both health condition and type of care. 3,10–13 The Health Care Cost Institute has produced 4 annual reports that assess health care spending for children, but their focus was on children who are covered by employer-based insurance.…”

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Spending on Children’s Personal Health Care in the United States, 1996-2013

et al. 2017

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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. OBJECTIVE 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. EVIDENCE REVIEW 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.FINDINGS 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(UI, -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.CONCLUSIONS AND RELEVANCE 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.

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“…Kuo et al 59 recently estimated primary care expenditures by Medicaid patients at $19 PMPM, 25% below our breakeven capitated rate. However, most commercial plans reimburse at higher rates than Medicaid plans, and our breakeven rate reflects the average of all patients in the practice.…”

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confidence: 78%

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice

et al. 2016

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Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance

Abstract: BACKGROUND AND OBJECTIVES: Opportunities to improve health care quality and contain spending may differ between high and low resource users. This study's objectives were to assess health care and spending among children with Medicaid insurance by their resource use.

Cited by 56 publications

References 28 publications

Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population

Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population

Spending on Children’s Personal Health Care in the United States, 1996-2013

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice

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