Trends in Health Care Spending for Children in Medicaid With High Resource Use
Trends in Health Care Spending for Children in Medicaid With High Resource Use
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DOI：
10.1542/peds.2016-0682
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发表时间：
2016-10-01
期刊：
影响因子：
8
通讯作者：
Berry, Jay G.
中科院分区：
文献类型：
--
作者：
Agrawal, Rishi;Hall, Matt;Berry, Jay G.
目的：为了评估与儿童高资源用户在Medicaid.METHODS中的医疗保健支出趋势相关的特征：这项回顾性分析包括48 743名1至18岁的儿童，他们从2009年至2013年连续参加了10个州的医疗补助计划（Truven MarketScan Medicaid Database），也是2010年所有医疗保健支出的前5%。使用多变量回归分析，评估基线人口统计学、临床和卫生服务特征之间的相关性（使用2009-2010年数据）与随后的医疗保健支出（即短暂、间歇、持续高）。结果：2011-2013年的高支出是暂时的，占54.2%，持续的占32.9%，间歇性的占12.9%。关于人口统计学特征，2010年，13至18岁儿童与1至2岁儿童持续性消费与短暂性消费的可能性最高（比值比[OR]，3.0 [95%置信区间（CI），2.7-3.4]）。关于临床特征，最高可能性是患有≥ 6种慢性疾病（OR，4.8 [95%CI，3.5-6.6]）、呼吸系统慢性疾病（OR，2.5 [95%CI，2.2-2.8]）或神经肌肉系统慢性疾病（OR，2.3 [95%CI，2.2-2.5]）的儿童。2010年的住院和急诊（艾德）使用与2011-2013年持续支出的可能性降低相关（住院OR，0.7 [95% CI，0.7-0.7]）;艾德OR，0.8 [95% CI，0.8-0.8]）。结论：大多数在医疗补助中花费高的儿童在随后的几年中没有持续的高花费。青少年年龄，多种慢性疾病，某些复杂的慢性疾病增加了持续高支出的可能性;医院和艾德的使用降低了它。这些数据可能有助于为开发新的护理和融资模式提供信息，以优化健康，节省资源，在儿童高资源使用。
OBJECTIVES: To assess characteristics associated with health care spending trends among child high resource users in Medicaid.METHODS: This retrospective analysis included 48 743 children ages 1 to 18 years continuously enrolled from 2009-2013 in 10 state Medicaid programs (Truven MarketScan Medicaid Database) also in the top 5% of all health care spending in 2010. Using multivariable regression, associations were assessed between baseline demographic, clinical, and health services characteristics (using 2009-2010 data) with subsequent health care spending (ie, transiently, intermittently, persistently high) from 2011-2013.RESULTS: High spending from 2011-2013 was transient for 54.2%, persistent for 32.9%, and intermittent for 12.9%. Regarding demographic characteristics, the highest likelihood of persistent versus transient spending occurred in children aged 13 to 18 years versus 1 to 2 years in 2010 (odds ratio [OR], 3.0 [95% confidence interval (CI), 2.7-3.4]). Regarding clinical characteristics, the highest likelihoods were in children with >= 6 chronic conditions (OR, 4.8 [95% CI, 3.5-6.6]), a respiratory complex chronic condition (OR, 2.5 [95% CI, 2.2-2.8]), or a neuromuscular complex chronic condition (OR, 2.3 [95% CI, 2.2-2.5]). Hospitalization and emergency department (ED) use in 2010 were associated with a decreased likelihood of persistent spending in 2011-2013 (hospitalization OR, 0.7 [95% CI, 0.7-0.7]); ED OR, 0.8 [95% CI, 0.8-0.8]).CONCLUSIONS: Most children with high spending in Medicaid are without persistently high spending in subsequent years. Adolescent age, multiple chronic conditions, and certain complex chronic conditions increased the likelihood of persistently high spending; hospital and ED use decreased it. These data may help inform the development of new models of care and financing to optimize health and save resources in children with high resource use.