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PEDIATRICS Vol. 112 No. 6 December 2003, pp. e440-e446

National Estimates of Health Services Expenditures for Children With Behavioral Disorders: An Analysis of the Medical Expenditure Panel Survey

James P. Guevara, MD, MPH^*,, David S. Mandell, ScD^*,,,||, Anthony L. Rostain, MD^||, Huaqing Zhao, MA^¶ and Trevor R. Hadley, PhD^,,||

^* Divisions of General Pediatrics
^¶ Biostatistics and Epidemiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Center for Mental Health Policy and Services Research, Philadelphia, Pennsylvania
^|| Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

Background. Children with attention-deficit/hyperactivity disorder and asthma incur similar health care costs that are greater than those of most children without these conditions. Preliminary findings suggest that children with emotional behavioral disorders, anxiety and depression, incur even greater costs.

Objective. To determine if children with behavioral disorders have similar health services expenditures as children with physical conditions and to assess whether children with emotional behavioral disorders incur greater expenditures than children with disruptive behavioral disorders.

Methods. Children 2 to 18 years old who were members of households participating in the 1996 Medical Expenditure Panel Survey were eligible for this retrospective cohort study. Children with common behavioral disorders selected a priori were identified by using truncated International Classification of Diseases (Ninth Revision) codes obtained from household interviews. Children with common physical conditions (asthma, epilepsy, and diabetes) and children without these conditions served as controls. Estimates were weighted to reflect the complex sampling scheme. Expenditures for health services were compared.

Results. Of 3955 eligible children weighted to represent >44 million, 7.1% were identified with a behavioral disorder: 4.5% with disruptive disorders; 2.1% with emotional disorders; and 0.5% with miscellaneous disorders. Children with behavioral disorders incurred overall expenditures similar to children with physical conditions (adjusted $1492 vs $1245; P = .18) but greater than children without these conditions (adjusted $1492 vs $834; P = .001). Children with behavioral disorders had greater expenditures for office-based visits (adjusted $410; 95% confidence interval: $146–672) and prescription medications (adjusted $361; 95% confidence interval: $72–648) than those of children in either control group. Among children with behavioral disorders, children with emotional disorders incurred substantially greater overall expenditures (adjusted $2152 vs $1026; P = .003) than children with disruptive disorders. Children with emotional disorders incurred greater hospitalization expenditures ($664 vs $43; P = .01) but lower pharmacy expenditures ($154 vs $307; P = .001) than children with disruptive disorders.

Conclusions. In this nationally representative sample, children with behavioral disorders incurred overall health care costs similar to children with physical conditions but greater than children without any of these conditions because of increased costs for office-based visits and prescription medications. However, costs were not uniform among children with behavioral disorders. Children with emotional disorders incurred twofold higher costs than children with disruptive disorders. Greater recognition of children with emotional disorders and efforts to address the high rate of hospitalizations in this population are warranted.

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Key Words: costs • mental health • children

Abbreviations: ADHD, attention-deficit/hyperactivity disorder • MEPS, Medical Expenditure Panel Survey • HC, household component • MPC, medical provider component • ICD-9, International Classification of Diseases, Ninth Revision • CCS, clinical classification software • CI, confidence interval

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Received for publication Mar 17, 2003; Accepted Aug 11, 2003.

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