Trends in Health Care Use and Spending for Young Children With Neurologic Impairment

• Published in: Pediatrics (Evanston) Vol. 149; no. 1; p. 1
• Main Authors: Bayer, Nathaniel D, Hall, Matthew, Li, Yue, Feinstein, James A, Thomson, Joanna, Berry, Jay G
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01.01.2022
• Subjects: Age; Ambulatory Care - statistics & numerical data; Care and treatment; Child health services; Child Health Services - statistics & numerical data; Child, Preschool; Children; Confidence intervals; Demographic aspects; Diagnosis; Economic aspects; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Facilities and Services Utilization; Female; Forecasts and trends; Health care; Health care costs; Home Care Services - statistics & numerical data; Hospitalization - statistics & numerical data; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Market trend/market analysis; Medicaid; Medical care; Medical care utilization; Medical care, Cost of; Mental Health Services - statistics & numerical data; Nervous system diseases; Nervous System Diseases - therapy; Neurologic Disorders; Outpatient care facilities; Pediatrics; Primary care; Primary Health Care - statistics & numerical data; Public Health; Retrospective Studies; System-Based Practice; Trends; United States; Utilization; United States
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2021-050905

Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009-2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0-5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. For children with early-onset NI from 0-5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.