This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ireys, H. T.
Right arrow Articles by Neff, J. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ireys, H. T.
Right arrow Articles by Neff, J. M.
Related Collections
Right arrow Office Practice

PEDIATRICS Vol. 100 No. 2 August 1997, pp. 197-204

Expenditures for Care of Children With Chronic Illnesses Enrolled in the Washington State Medicaid Program, Fiscal Year 1993

Received Oct 16, 1996; accepted Feb 19, 1997.

Henry T. Ireys*, Gerard F. AndersonDagger , Tom J. ShafferDagger , and John M. Neff§

From the Departments of * Maternal and Child Health, and Dagger  Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland; and § Children's Hospital & Medical Center, University of Washington School of Medicine, Seattle, Washington.

Objective.  We calculated expenditures for children with one of eight selected chronic health conditions who were enrolled in the Washington State Medicaid program and compared them with payments for all Medicaid-enrolled children. We examined variation in mean, median, and total expenditures and identified expenditure sources.

Methods.  This study analyzed Medicaid claims data for 310 977 children aged 0 to 18 who were enrolled at any time in fiscal year 1993. Tracer conditions were used to examine expenditure variation within and between diagnostic groupings. A total of 18 233 children (5.9%) had at least one of the conditions. Expenditures were calculated based on payments made by the Medicaid program.

Results.  Children with one of the eight selected conditions incurred mean expenditures of $3800, compared with $955 for all Medicaid-enrolled children. Mean payments associated with the selected conditions ranged from 2.5 times to 20 times more than payments to all children. Approximately 10% of children accounted for approximately 70% of the payments in general and in each diagnostic grouping. Variation in mean, median, and total expenditures was extensive among the conditions. For most conditions, inpatient stays accounted for the greatest proportion of expenditures; for some conditions, durable equipment, home nursing, and medication-related services accounted for substantial proportions of total expenditures.

Conclusions.  Medical care for children with selected chronic health conditions is 2.5 to 20 times more expensive than children in general, depending on the condition. A relatively few children account for the majority of expenditures. Extensive variation in mean, median, and total expenditures suggests that different conditions will need to be kept distinct for purposes of establishing payment rates. Children with certain conditions are vulnerable to restrictions in specific services, depending on what restrictions are imposed by a financing program. Further analyses are needed to identify risk-adjustment strategies to support delivery of high-quality services to this population of children as they migrate into managed-care environments.

Key words: chronic illness, Medicaid, costs, asthma, cerebral palsy, chronic respiratory disease, cystic fibrosis, diabetes, muscular dystrophy, malignant neoplasms, spina bifida.




This article has been cited by other articles:


Home page
 CLIN PEDIATRHome page
A. Kelly and K. Khan
Prevalence of Allergies in Children With Complex Medical Problems
Clinical Pediatrics, October 1, 2008; 47(8): 809 - 816.
[Abstract] [PDF]

Home page
 J Child NeurolHome page
L. Ouyang, S. D. Grosse, and A. Kenneson
Health Care Utilization and Expenditures for Children and Young Adults With Muscular Dystrophy in a Privately Insured Population
J Child Neurol, August 1, 2008; 23(8): 883 - 888.
[Abstract] [PDF]

Home page
 NEJMHome page
E. Baraldi and M. Filippone
Chronic Lung Disease after Premature Birth
N. Engl. J. Med., November 8, 2007; 357(19): 1946 - 1955.
[Full Text] [PDF]

Home page
 PediatricsHome page
K. A. Campbell, R. P. Berger, L. Ettaro, and M. S. Roberts
Cost-effectiveness of Head Computed Tomography in Infants With Possible Inflicted Traumatic Brain Injury
Pediatrics, August 1, 2007; 120(2): 295 - 304.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
P. J. Chung, C. F. Garfield, M. N. Elliott, C. Carey, C. Eriksson, and M. A. Schuster
Need for and Use of Family Leave Among Parents of Children With Special Health Care Needs
Pediatrics, May 1, 2007; 119(5): e1047 - e1055.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
G. S. Liptak, L. P. Shone, P. Auinger, A. W. Dick, S. A. Ryan, and P. G. Szilagyi
Short-term Persistence of High Health Care Costs in a Nationally Representative Sample of Children
Pediatrics, October 1, 2006; 118(4): e1001 - e1009.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Public HealthHome page
I. Nathanson, G. Ramirez-Garnica, and S. A. Wiltrout
Decreased Attendance at Cystic Fibrosis Centers by Children Covered by Managed Care Insurance
Am J Public Health, November 1, 2005; 95(11): 1958 - 1963.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
Council on Children With Disabilities
Care Coordination in the Medical Home: Integrating Health and Related Systems of Care for Children With Special Health Care Needs
Pediatrics, November 1, 2005; 116(5): 1238 - 1244.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
S. Berman, M. Rannie, L. Moore, E. Elias, L. J. Dryer, and M. D. Jones Jr
Utilization and Costs for Children Who Have Special Health Care Needs and Are Enrolled in a Hospital-Based Comprehensive Primary Care Clinic
Pediatrics, June 1, 2005; 115(6): e637 - e642.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
T. V. Williams, E. M. Schone, N. D. Archibald, and J. W. Thompson
A National Assessment of Children With Special Health Care Needs: Prevalence of Special Needs and Use of Health Care Services Among Children in the Military Health System
Pediatrics, August 1, 2004; 114(2): 384 - 393.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. C. Brehaut, D. E. Kohen, P. Raina, S. D. Walter, D. J. Russell, M. Swinton, M. O'Donnell, and P. Rosenbaum
The Health of Primary Caregivers of Children With Cerebral Palsy: How Does It Compare With That of Other Canadian Caregivers?
Pediatrics, August 1, 2004; 114(2): e182 - e191.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
J. E. Tyson and L. C. Gilstrap
Hope for Perinatal Prevention of Cerebral Palsy
JAMA, November 26, 2003; 290(20): 2730 - 2732.
[Full Text] [PDF]

Home page
 PediatricsHome page
R. E. K. Stein, E. Shenkman, D. H. Wegener, and E. J. Silver
Health of Children in Title XXI: Should We Worry?
Pediatrics, August 1, 2003; 112(2): e112 - 118.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
J. M. Neff, J. Valentine, A. Park, J. Hicks-Thomson, D. A. Christakis, J. Muldoon, and S. Churchill
Trends in Pediatric Hospitalizations of Children in Washington State by Insurance and Chronic Condition Status, 1991-1998
Arch Pediatr Adolesc Med, July 1, 2002; 156(7): 703 - 709.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
N. P. Dosa, N. M. Boeing, N. MS, and R. K. Kanter
Excess Risk of Severe Acute Illness in Children With Chronic Health Conditions
Pediatrics, March 1, 2001; 107(3): 499 - 504.
[Abstract] [Full Text]

Home page
 PediatricsHome page
J. A. Finkelstein, P. Lozano, R. Shulruff, T. S. Inui, S. B. Soumerai, M. Ng, and K. B. Weiss
Self-Reported Physician Practices for Children With Asthma: Are National Guidelines Followed?
Pediatrics, October 1, 2000; 106(4): 886 - 896.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
B. Berman
The Academic Children's Hospital Primary Care Clinic: Responding to tie Challenges of a Changing Health Care Environment
Clinical Pediatrics, August 1, 2000; 39(8): 473 - 478.
[Abstract] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
J. A. Finkelstein, M. B. Barton, J. G. Donahue, P. Algatt-Bergstrom, L. E. Markson, and R. Platt
Comparing Asthma Care for Medicaid and Non-Medicaid Children in a Health Maintenance Organization
Arch Pediatr Adolesc Med, June 1, 2000; 154(6): 563 - 568.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
T. A. Lieu, G. T. Ray, G. Farmer, and G. F. Shay
The Cost of Medical Care for Patients With Cystic Fibrosis in a Health Maintenance Organization
Pediatrics, June 1, 1999; 103(6): 72e - 72.
[Abstract] [Full Text]

Home page
 Arch Pediatr Adolesc MedHome page
J. H. Silber, S. P. Gleeson, and H. Zhao
The Influence of Chronic Disease on Resource Utilization in Common Acute Pediatric Conditions: Financial Concerns for Children's Hospitals
Arch Pediatr Adolesc Med, February 1, 1999; 153(2): 169 - 179.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
K. Kuhlthau, J. M. Perrin, S. L. Ettner, T. J. McLaughlin, and S. L. Gortmaker
High-expenditure Children With Supplemental Security Income
Pediatrics, September 1, 1998; 102(3): 610 - 615.
[Abstract] [Full Text] [PDF]