Assessing the social determinants of health care costs for Medicaid‐enrolled adolescents in Washington State using administrative data

• Published in: Health services research Vol. 54; no. 1; pp. 52 - 63
• Main Authors: Patton, Deleena A., Liu, Qinghua, Adelson, Jaimie D., Lucenko, Barbara A.
• Format: Journal Article
• Language: English
• Published: United States Health Research and Educational Trust 01.02.2019; Blackwell Publishing Ltd; John Wiley and Sons Inc
• Subjects: administrative data; Adolescence; Adolescent; Adolescent Health Services - economics; Adolescent Health Services - statistics & numerical data; Adolescents; Behavioral medicine; Child abuse; Child abuse & neglect; child abuse and neglect; Child health; Child placement; Child welfare; Children; Costs; Data; Early intervention; Expenditures; Family; Female; Forecasts and trends; Foster care; Foster children; Government programs; Government regulation; Health behavior; Health care costs; Health care expenditures; health expenditures; Health risks; Health services; Health Services Accessibility - economics; Health services utilization; Help seeking behavior; Humans; Laws, regulations and rules; Male; Market trend/market analysis; Medicaid; Medicaid - economics; Medicaid - statistics & numerical data; Medical care utilization; Medical care, Cost of; Medical economics; Medicine; Parents & parenting; Placement; Prevention programs; Primary Health Care - economics; Regression analysis; Regression models; Risk analysis; Risk factors; Social Determinants of Health; Social Determinants of Health - economics; Social Determinants of Health - statistics & numerical data; Social factors; Social services; Stability; Statistics; United States; Washington; Youth; United States; Washington; child welfare; Medicaid; administrative data; child abuse and neglect; health expenditures
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.13052

Objective The study used administrative data to identify the social determinants that have the greatest impact on Medicaid expenditures in adolescence. Data Sources Data were compiled using the Washington State Department of Social and Health Services Integrated Client Databases, which link data from state systems including Medicaid claims and social services receipt. Study Design Medical system and behavioral health service costs of over 180 000 Medicaid‐enrolled adolescents aged 12‐17 were measured using integrated administrative data from Washington State. Social determinants of health, including child maltreatment and parent risk factors, were also measured. Two‐stage regression models were used to identify factors associated with increased health care utilization and costs. Principal Findings Regression models revealed that the factors most predictive of higher health care costs were child abuse, child neglect, and instability in out‐of‐home placements related to foster care. Other social determinants of health, such as parent risk factors, were not associated with health care costs. Child maltreatment and placement instability impacted health care costs primarily through large increases in behavioral health utilization and costs. Conclusions Prevention and early interventions for children and families to decrease child maltreatment and increase foster care placement stability could reduce overall health care costs.