A national profile of health care utilization and expenditures for children with special health care needs.

Abstract

To provide the first nationally representative data on total health care expenses, out-of-pocket health care expenses, and information on the extent to which out-of-pocket expenses are financially burdensome for families of children with special health care needs (CSHCN). To also compare utilization and expenditure patterns for children with and without special health care needs.
We used data from the 2000 Medical Expenditure Panel Survey (MEPS). We present univariate, bivariate, and multivariate statistics on utilization and expenditures adjusted for the complex sample design.
The 2000 MEPS data set contains 6965 children younger than 18 years. Using the CSHCN definition adopted by the federal Maternal and Child Health Bureau and operationalized using the CSHCN Screener, 949 children (15.6%) were identified as children with special health care needs.
Compared with other children, CSHCN had 3 times higher health care expenditures (2099 dollars vs 628 dollars; P<.01). The 15.6% of CSHCN accounted for 42.1% of total medical care costs (excluding dental costs) and 33.6% of total health care costs (including dental costs) attributed to children in 2000. Families of CSHCN were best protected against inpatient hospital care expenses and most exposed to dental care expenses. Families of CSHCN experiencing high out-of-pocket expenses (exceeding 5% of family income) were approximately 11 times more likely to be from households with incomes below 200% of the federal poverty level (odds ratio, 10.9; 95% confidence interval, 3.55-33.76) than to be from families with incomes at or above 400% of the federal poverty level.
Families with CSHCN experience much higher expenditures, including out-of-pocket expenditures, than other children. Insurance plays an important protective role for families of CSHCN, but it still provides incomplete protection. Health policy changes that would extend the breadth and depth of insurance coverage are needed to ensure that all families of CSHCN are protected against burdensome expenses.

Full text

Page 1

ARTICLE
A National Profile of Health Care Utilization
and Expenditures for Children With Special
Health Care Needs
Paul W. Newacheck, DrPH; Sue E. Kim, PhD
Objectives: To provide the first nationally representa-
tive data on total health care expenses, out-of-pocket
health care expenses, and information on the extent to
which out-of-pocket expenses are financially burden-
someforfamiliesofchildrenwithspecialhealthcareneeds
(CSHCN). To also compare utilization and expenditure
patternsforchildrenwithandwithoutspecialhealthcare
needs.
Design: We used data from the 2000 Medical Expen-
diture Panel Survey (MEPS). We present univariate, bi-
variate, and multivariate statistics on utilization and ex-
penditures adjusted for the complex sample design.
Participants: The 2000 MEPS data set contains 6965
children younger than 18 years. Using the CSHCN defi-
nitionadoptedbythefederalMaternalandChildHealth
Bureau and operationalized using the CSHCN Screener,
949children(15.6%)wereidentifiedaschildrenwithspe-
cial health care needs.
Main Outcome Measures: Compared with other chil-
dren, CSHCN had 3 times higher health care expendi-
tures($2099vs$628;P?.01).The15.6%ofCSHCNac-
countedfor42.1%oftotalmedicalcarecosts(excluding
dental costs) and 33.6% of total health care costs (in-
cludingdentalcosts)attributedtochildrenin2000.Fami-
liesofCSHCNwerebestprotectedagainstinpatienthos-
pital care expenses and most exposed to dental care
expenses.FamiliesofCSHCNexperiencinghighout-of-
pocket expenses (exceeding 5% of family income) were
approximately 11 times more likely to be from house-
holds with incomes below 200% of the federal poverty
level (odds ratio, 10.9; 95% confidence interval, 3.55-
33.76)thantobefromfamilieswithincomesatorabove
400% of the federal poverty level.
Conclusions: Families with CSHCN experience much
higher expenditures, including out-of-pocket expendi-
tures, than other children. Insurance plays an impor-
tantprotectiveroleforfamiliesofCSHCN,butitstillpro-
vides incomplete protection. Health policy changes that
would extend the breadth and depth of insurance cov-
erage are needed to ensure that all families of CSHCN
are protected against burdensome expenses.
Arch Pediatr Adolesc Med. 2005;159:10-17
C
ioral,oremotionalconditionandwhoalso
requirehealthandrelatedservicesofatype
or amount beyond that required by chil-
dren generally,1use more health care
services than other children2,3and con-
sequently have higher health care expen-
ditures.Onestudy4estimatedthatCSHCN
account for about 80% of all health care
expenses for children even though they
make up less than 20% of the child popu-
lation. However, that estimate was based
on an assessment of the literature on uti-
lizationpatternsforchildrenwithchronic
illnessesanddisabilitiesandwasnotbased
HILDREN WITH SPECIAL
healthcare
(CSHCN), defined as
those children who have
orareatincreasedriskfor
needs
achronicphysical,developmental,behav-
on representative national expenditure
data.
In fact, there are no studies that docu-
menthealthcareexpendituresforCSHCN
using nationally representative data. Sev-
eral studies have assessed health care uti-
lization and spending patterns for chil-
dren with selected chronic conditions.
Lozano et al5provided estimates of the
costs of caring for children with asthma.
Chanandcolleagues6examinedhealthcare
costs for children with attention-deficit/
hyperactivity disorder, while Ringel and
Sturm7estimated the costs of childhood
mental health disorders. Analyses of ex-
pendituresforlowerincomechildrenwith
disabilities receiving Supplemental Secu-
rity Income have been published by Neff
et al8and Kuhlthau et al.9Other studies
haveusedadministrativedatafromhealth
Author Affiliations: Institute
for Health Policy Studies and
Department of Pediatrics,
University of California, San
Francisco (Dr Newacheck);
Institute for Health Policy
Studies and Division of General
Internal Medicine, University of
California, San Francisco
(Dr Kim).
(REPRINTED) ARCH PEDIATR ADOLESC MED/VOL 159, JAN 2005WWW.ARCHPEDIATRICS.COM
10
©2005 American Medical Association. All rights reserved.
at Univ of Colorado Hlth Sci Ctr, on October 18, 2006 www.archpediatrics.com Downloaded from

Page 2

plans,Medicaid,andTitleXXIprogramstoexaminehealth
carespendingpatternsforchildrenandadolescentswith
chronic conditions.10-12
Although these studies continue to be of great value,
none has used the CSHCN definition cited above and
adopted by the federal Maternal and Child Health Bu-
reau (MCHB) as the basis for estimating expenditures.
Although it is possible to define CSHCN in many ways,
theMCHBdefinitionisusedinall50statesforplanning
andpolicypurposes.Understandingthenatureofhealth
careexpensesforthispopulationisimportantforhealth
planning efforts by public agencies such as the federal
and state Title V CSHCN programs. Information on the
distribution of health care expenditures is also impor-
tant for devising appropriate benefit packages and effi-
cient payment mechanisms under public and private
health insurance. Information on the correlates of high
healthcareexpenditures,especiallythosewithhighout-
of-pocket expenses, is important in developing strate-
gies to protect families against experiencing cata-
strophichealthcareexpenses.Allofthisinformationcan
be useful to practitioners in understanding the needs of
their CSHCN patients.
New data from the Medical Expenditure Panel Sur-
vey (MEPS) are now available to fill many of the exist-
ing gaps in our knowledge of health care expenditures
forCSHCN.The2000editionofMEPSincorporatedthe
CSHCNScreener,atoolforidentifyingCSHCN,thatwas
specifically designed to operationalize the federal defi-
nition presented above. The 2000 MEPS provides a new
capacity to assess the nature and distribution of health
careexpendituresforCSHCN.Usingthissurvey,wepro-
vide the first national data on health care expenses and
out-of-pockethealthcareexpensesforchildrenwithand
without special health care needs. We also use the sur-
vey to describe the extent to which out-of-pocket ex-
pensesarefinanciallyburdensomeforfamiliesofCSHCN.
METHODS
The MEPS is designed to produce national estimates of health
care use, expenditures, and insurance coverage of the US ci-
viliannoninstitutionalizedpopulation.Thesurveyusesanover-
lappingpaneldesigninwhichdataarecollectedthroughapre-
liminary contact followed by a series of 5 rounds of interviews
duringa2½-yearperiod.13Datawerecollectedforeachsample
personattheeventlevelandsummedupacrossroundstopro-
duce the annual utilization and expenditure data. The overall
response rate for the survey was 65.8%. A total of 6965 chil-
dren younger than 18 years with valid response data were in-
cluded in our study. A knowledgeable adult, usually a parent,
answered questions in person and by telephone about health
and health services use for children younger than18 years.
VARIABLE CONSTRUCTION
The CSHCN Screener identified children who had a medical,
behavioral, or other health condition that has lasted or is ex-
pected to last at least 1 year, and reported at least 1 of the fol-
lowing consequences of the condition: using or needing more
medicalcare,mentalhealthservices,oreducationservicesthan
other children of the same age; using or needing prescription
medication; having limitations in their ability to do the things
mostchildrenofthesameagedo;usingorneedingspecialthera-
pies, such as physical, occupational, or speech therapy; or us-
ing or needing emotional, developmental, or behavioral treat-
mentorcounseling.Parentscompletedawrittenversionofthe
CSHCN Screener for each child in the family. The CSHCN
Screener was designed to operationalize the MCHB definition
ofCSHCN,excludingthose“atrisk”forspecialhealthcareneeds.
ThedevelopmentprocessandtechnicalpropertiesoftheCSHCN
Screener are described elsewhere.14
Total health care expenditures, or costs, included expendi-
tures for hospital inpatient and outpatient services, physician
services, dental services, services provided by health care pro-
fessionalsotherthanphysicians(eg,nursepractitioners,physi-
cal therapists, psychologists, and social workers), prescribed
medications,diagnostictests,andcertaintypesofmedicalequip-
mentandsuppliesincludingeyeglassesandcontactlenses.Some
specialized long-term care services and equipment, as well as
services provided in schools, and institutionalized settings are
excluded from MEPS.
A key outcome variable in this study is the financial bur-
denofout-of-pocketexpenses.Out-of-pocketexpendituresare
defined as the payments made by families for health care and
includeout-of-pocketspendingondeductiblesandotherforms
of cost sharing. Cost sharing includes copayments and coin-
surance,anddirectexpendituresforhealthcareservices,equip-
ment, and supplies not covered by insurance (excluding pre-
miums). We measure financial burden using absolute and
relativemethods.Theabsolutemeasuresarebasedonwhether
thechild’sout-of-pocketexpensesexceedthethresholdsof$500
and$1000annually.Althoughsomewhatarbitrary,thesethresh-
olds are commonly used to indicate burdensome levels of in-
dividual health care expenditures. The relative measures in-
clude the share of annual family income spent out-of-pocket
on the child’s health care (ie, the ratio of out-of-pocket ex-
penses for health care per $1000 of family income) and out-
of-pocket expenditures exceeding 5% of family income.
STATISTICAL ANALYSIS
Estimates presented in the tables and text have been statisti-
callyweightedtoreflectnationalpopulationtotals.Theweights,
provided by the data collection agency, are equal to the in-
verseofthesamplingprobabilityforeachcase,adjustedfornon-
response. We present our results in the form of distributional
statistics (Figure1 and Figure 2) as well as bivariate
(Tables 1, 2 , 3, and 4) and multivariate (Table 5) statis-
ticalanalyses.Logisticregressionmodelswereusedinthefirst
3multivariatemodelsandordinaryleast-squaresregressionwas
used for the last model in Table 5. We used a semilog linear
model for the last regression because the underlying distribu-
tion of expenses was skewed. Standard errors and test statis-
ticsforthebivariateandmultivariateanalyseswerederivedus-
ingStatasoftware(StataCorp,CollegeStation,Tex)thattakes
into account the complex sample design of the survey.15Our
analysisofsecondarydatafromtheMEPSwasapprovedbythe
University of California (San Francisco) Committee on Hu-
man Research.
RESULTS
PREVALENCE OF SPECIAL HEALTH CARE NEEDS
An estimated 11 million US children (15.6%) younger
than18yearshadaspecialhealthcareneedin2000.Preva-
lenceofspecialhealthcareneedsvariedaccordingtothe
demographic and socioeconomic characteristics of chil-
(REPRINTED) ARCH PEDIATR ADOLESC MED/VOL 159, JAN 2005WWW.ARCHPEDIATRICS.COM
11
©2005 American Medical Association. All rights reserved.
at Univ of Colorado Hlth Sci Ctr, on October 18, 2006 www.archpediatrics.com Downloaded from

Page 3

dren and their families (Table 1). Prevalence was higher
amongschool-agechildren,boys,whitenon-Hispanicchil-
dren,andinsuredchildren.About6%ofCSHCNin2000,
estimated to be about 510000 children nationally, did
not have health insurance.
USE OF HEALTH SERVICES
UtilizationdatafromtheMEPSindicatethatCSHCNuse
many more services than other children (Table 2). Spe-
cifically, CSHCN had about 4 times the number of hos-
pitalizations (89 vs 22 discharges per 1000; P?.01) and
spentmorethan7timesasmanydaysinhospitalsasother
children (370 vs 49 days per 1000; P?.01). Although
CSHCN account for less than 16% of the child popula-
tion,theyaccountedfor52.5%ofchildren’shospitaldays.
TheMEPSdataalsoshowthatCSHCNhadmorethan
twiceasmanyphysicianvisits(4.35vs1.75;P?.01)and
7timesasmanynonphysicianvisits(2.17vs0.30;P?.01)
asotherchildrenonanannualbasis.Nonphysicianhealth
professionals include nurse practitioners and physician
assistants who work on their own or with a physician,
aswellaspsychologists,socialworkers,andphysicalthera-
pists. Although the average number of emergency de-
partmentvisitswaslow,CSHCNhadabout1.5timesmore
annual visits than other children (0.22 vs 0.14; P?.01).
There were also significant differences present for pre-
scriptionmedicationusage;CSHCNused5timesthenum-
ber of prescribed medications per year than other chil-
dren (6.94 vs 1.22; P?.01) and used substantially more
home health provider days on an annual basis than other
children (1.73 vs 0.002; P?.01); approximately 87% of
homehealthcaredayswereaccountedforbyCSHCN.In
contrast,theannualvolumeofdentalcarevisitswassimi-
larforchildrenwithandwithoutspecialhealthcareneeds.
EXPENDITURES FOR HEALTH SERVICES
Total health care expenditures averaged $2099 for
CSHCN, more than 3 times the average of $628 for chil-
drenwithoutspecialhealthcareneeds(P?.01)(Table3).
A comparison of expenditures by type of health service
shows differences that parallel those described for utili-
zation. For example, CSHCN had almost 4 times higher
hospitalcareexpenses($361vs$96;P?.01),morethan
doubletheamountofphysicianservicesexpenses($406
vs $150; P?.01), and 6 times greater nonphysician ser-
vicesexpensesthanchildrenwithoutspecialhealthcare
needs ($144 vs $24; P?.01). Average expenditures on
prescribed medications were 10 times higher ($340 vs
$34;P?.01)andhomehealthexpensesweremuchgreater
than those of other children. Average expenditures for
CSHCN on “other” medical services were about twice
thoseforotherchildren($37vs$16;P?.01).Therewere
nosignificantdifferencesinaverageexpendituresforden-
tal services ($241 vs $259; P=.20).
Therelativedifferencesinexpendituresresultinvery
differentpatternsofhealthcareexpensesforchildrenwith
andwithoutspecialhealthcareneeds(Figure1).Forex-
ample, dental care accounts for only about one tenth of
totalexpensesforCSHCNbutmorethanonethirdofex-
pendituresforchildrenwithoutspecialhealthcareneeds.
In contrast, prescription medications and home health
care together account for one third of health care ex-
pensesforCSHCNbutaccountforonlyaboutonetwen-
tieth of spending for other children.
Average out-of-pocket expenditures (those paid di-
rectlybythefamily)forCSHCNaretwicethoseforother
children ($352 vs $174; P?.01) (Table 3). For both
groups, the largest component of out-of-pocket ex-
penseswasfordentalservices.AmongCSHCN,theshare
of health care bills paid out-of-pocket varied dramati-
callybytypeofservice.WhereasTable3showsthatonly
about 2% of inpatient hospital expenses were paid out-
of-pocket , 15% of physician and nonphysician services,
29% of prescription medicine, and 55% of dental ex-
penses were paid out-of-pocket for CSHCN.
Asistrueforotherpopulations,totalexpendituresand
out-of-pocket expenses for CSHCN are highly skewed
(Figure2).Themediantotalexpenseforhealthcarewas
$558,whiletheupperdecileofchildrenaccumulatedex-
penses of $4304 or more. This upper decile of children
accountedfor61%ofallhealthcareexpensesforCSHCN.
70
80
90
100
60
50
40
30
20
10
0
Not CSHCNCSHCN
Percentage
Home Health
Prescription
Other
Hospital
Medical Visits
Dental
Figure 1. Composition of health care expenditures for children with and
without special health care needs in the United States in 2000. CSHCN
indicates children with special health care needs.
3500
4000
4500
3000
2500
2000
1500
1000
500
0
10th20th30th 40th 60th50th70th 80th90th
Percentile
Expenditures, $
Out-of-Pocket
Total
037
2134
25
269
56
397
100
558
152
852
260
1215
410
1955
811
4304
Figure 2. Percentage distribution of total and out-of-pocket expenditures for
children with special health care needs in the United States in 2000.
(REPRINTED) ARCH PEDIATR ADOLESC MED/VOL 159, JAN 2005WWW.ARCHPEDIATRICS.COM
12
©2005 American Medical Association. All rights reserved.
at Univ of Colorado Hlth Sci Ctr, on October 18, 2006 www.archpediatrics.comDownloaded from

Page 4

Homehealthandhospitalexpensesaccountedforthema-
jority of the expenditures for the upper decile of chil-
dren.
Out-of-pocket expenses were also skewed. The me-
dian annual out-of-pocket expense for health care was
$100, while the top 10% had expenses totaling $811 or
more. This upper decile accounted for 54% of out-of-
pocket expenses for CSHCN. Expenses for dental care
and prescription medications accounted for the major-
ity of out-of-pocket expenses for children in this group.
PREDICTORS OF HEALTH CARE SPENDING
Theprevalenceoffinanciallyburdensomehealthcareex-
penseforCSHCNispresentedinTable4.Certaindemo-
graphicandsocioeconomiccharacteristics,includingage,
race/ethnicity, and poverty status, were significantly as-
sociatedwithout-of-pocketexpendituresexceeding$500.
Race/ethnicity, sex, and poverty were significantly asso-
ciatedwithout-of-pocketexpensesinexcessof5%offam-
ilyincome.Childrenwithspecialhealthcareneedswith
expenses above 5% of family income were dispropor-
tionately from households with incomes below 200% of
the federal poverty level (FPL).
The 4 multivariate analyses in Table 5 show whether
and how age, sex, race/ethnicity, poverty, and insur-
ance status of CSHCN are independently related to out-
of-pockethealthcarespending.Thefirstequationshows
that adolescents (odds ratio [OR], 2.09; 95% confi-
dence interval [CI], 1.10-3.97) and uninsured children
(OR, 2.07; 95% CI, 0.99-4.33) had 2 times higher odds
of experiencing out-of-pocket expenditures in excess of
$500.ThoseCSHCNwhowereblack(OR, 0.39;95%CI,
0.17-0.90) or living in households at less than 200% of
theFPL(OR, 0.37;95%CI,0.21-0.65)hadsignificantly
lower odds of out-of-pocket expenses in excess of $500.
Similarly, CSHCN who were black (OR,0.02; 95% CI,
0.003-0.21)orfromlow-incomefamilies(OR,0.43;95%
Table 1. Prevalence of Special Health Care Needs Among Children Younger Than 18 Years in 2000*
Population
Characteristic Sample
Sample
of CSHCN
Estimated Total
Population (in Thousands)
Estimated No. of
CSHCN (in Thousands)Prevalence, %
Total
Age, y
?6
6-11
12-17
Sex
Male
Female
Race/ethnicity
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
Poverty status
?200% FPL
200%-399% FPL
?400% FPL
Insurance status
Insured
Uninsured
6965 949 68539
10699 15.61
2017
2557
2391
180
354
415
20171
24585
23783
2076
4020
4602
10.29
16.35
19.35
3567
3398
564
385
35346
33193
6482
4216
18.34
12.70
3273
1183
2291
218
568
156
213
12
43495
10863
11227
2954
7886
1553
1122
135
18.13
14.30
9.99
4.58
3356
2187
1422
406
308
235
25161
23228
20150
3812
3470
3415
15.15
14.94
16.95
6149
816
890
59
62418
6121
10187
510
16.32
8.33
Abbreviations: CSHCN, children with special health care needs; FPL, federal poverty level.
*Data source: 2000 Medical Expenditure Panel Survey.
Table 2. Use of Health Services by Special Needs Status Among Children Younger Than 18 Years in 2000*
Hospital
Discharges
per 1000
Hospital
Days per 1000
Physician
Visits†
Nonphysician
Visits‡
Emergency
Department Visits
Prescribed
Medications
Home Health
Provider DaysDental Visits
With SHCN§
Without SHCN
All children
89 (15)
22 (3)
31 (2)
370 (93)
49 (7)
96 (16)
4.35 (0.251)
1.75 (0.052)
2.15 (0.062)
2.17 (0.251)
0.30 (0.028)
0.62 (0.048)
0.22 (0.022)
0.14 (0.006)
0.15 (0.006)
6.94 (0.350)
1.22 (0.048)
2.16 (0.076)
1.73 (0.669)
.002 (0.001)
0.27 (0.103)
1.29 (0.115)
1.23 (0.049)
1.22 (0.047)
Abbreviation: SHCN, special health care needs.
*Data source: 2000 Medical Expenditure Panel Survey; data are given as number (SE) and represent the annual average.
†Includes office-based and hospital outpatient visits to physicians.
‡Includes office-based and hospital outpatient visits to nonphysicians. Nonphysician visits include visits to chiropractors, midwives, nurses and nurse
practitioners, optometrists, podiatrists, physician’s assistants, physical therapists, occupational therapists, psychologists, social workers, technicians,
receptionists/clerks/secretaries, or other medical providers.
§t Test significant at .01 level when comparing children with and without special health care needs.
(REPRINTED) ARCH PEDIATR ADOLESC MED/VOL 159, JAN 2005WWW.ARCHPEDIATRICS.COM
13
©2005 American Medical Association. All rights reserved.
at Univ of Colorado Hlth Sci Ctr, on October 18, 2006 www.archpediatrics.comDownloaded from

Page 5

CI, 0.22-0.86) were less likely to exceed the threshold
of out-of-pocket expenditures in excess of $1000.
ThethirdandfourthcolumnsofTable5showthelevel
of financial burden experienced by families as assessed
by out-of-pocket spending relative to income. Families
with low incomes experienced higher levels of financial
burden. Compared with families with incomes above
400% of the FPL, children in households with incomes
lessthan200%oftheFPLwere11timesmorelikelythan
their counterparts to experience out-of-pocket ex-
penses exceeding 5% of family income (OR,10.9; 95%
CI, 3.55-33.76). When financial burden was expressed
as a share of income, children in households with in-
comeslessthan200%oftheFPLspentabout164%more
of their family’s income on health care (95% CI, 87%-
267%) and those living in households with incomes be-
tween200%and400%oftheFPLspentabout46%(95%
CI, 7%-102%) more than their counterparts in house-
holds with incomes at or above 400% of the FPL. Al-
though insurance status was not independently related
tohavingout-of-pocketexpensesinexcessof5%offam-
ily income, children in households without insurance
spent 86% more of their family incomes on health care
than families with health insurance.
COMMENT
Resultsfromthe2000MEPSindicatethat15.6%ofchil-
drenhadaspecialhealthcareneedatthetimeofthesur-
vey. This estimate differs from the 12.9% prevalence es-
timate generated from the 2001 National Survey of
CSHCN.16Althoughbothsurveysusedthesamescreen-
ingquestionstoidentifyCSHCN,theydifferedinmode;
the MEPS used a parent-administered written question-
naire for each child in the household, and the National
Survey of CSHCN used a telephone interview method
where the screening questions were administered “fam-
ily style” for all children in the household at one time.
These differences in administration may account for the
prevalence differential.
The MEPS provides the first nationally representa-
tive data on health care utilization and expenditures for
CSHCN using an identification tool designed to capture
the federal MCHB definition of the population. Because
children are defined as having special health care needs
if they have an elevated need for services, we expected
to find higher use and expenditures for this population.
Indeed,ourpurposewastoquantifytheextentofdiffer-
encesinuseandexpendituresforchildrenwithandwith-
out special health care needs. Our results show that
CSHCN use many more services and have significantly
higher health care expenses than other children. For in-
patient hospital care, services provided by nonphysi-
cianhealthprofessionals,prescriptions,andhomehealth
services, use levels for CSHCN that are at least 5-fold
higherthanthoseofotherchildren.Onlyvolumeofden-
tal care visits is similar for the 2 populations. These dif-
ferences translate into higher expenditures for CSHCN;
there is a 3-fold difference overall and even larger dif-
ferences for hospital care, nonphysician services, pre-
Table 3. Average Total Health Care Expenditures and Out-of-Pocket Expenditures by Special Needs Status
for Children Younger Than 18 in 2000*
All
Services
Hospital
Inpatient
Services†
Physician
Services‡
Nonphysician
Services§
Emergency
Department
Services
Prescribed
Medications
Home
Health
Care
Dental
Services
Other
Services?
Average total health care
expenditures
With SHCN
Without SHCN
All children
Out-of-pocket expenditures
With SHCN
Without SHCN
All children
Share of total expenditures paid
out-of-pocket (%)
With SHCN
Without SHCN
All children
2099# (252.0) 361 (83.2)# 406 (41.9)#
628 (35.0)96 (16.6)
852 (49.0) 133 (17.9)
144 (23.0)#
24 (2.8)
45 (4.5)
66 (10.2)# 340 (35.0)# 481# (240.2) 241 (32.4)
48 (6.5)34 (1.9)
49 (5.2)85 (6.5)
37 (6.2)#
16 (1.1)
19 (1.3)
150 (8.8)
191 (11.3)
1 (0.6)
76 (36.5)
259 (24.2)
250 (19.8)
352 (34.3)#
174 (13.6)
203 (12.6)
6 (2.1)¶
7 (2.2)
6 (1.7)
65 (8.1)#
27 (1.4)
33 (1.6)
20 (3.6)#
5 (0.6)
9 (1.4)
6 (1.9)
5 (0.7)
5 (0.6)
97 (6.6)#
14 (1.0)
30 (1.9)
?1
?1
?1
133 (27.0)¶
105 (12.5)
107 (11.2)
19 (2.5)
11 (0.8)
12 (0.8)
16.8 (2.6)
27.7 (2.7)
23.8 (2.0)
1.7 (0.7)
7.3 (2.6)
4.5 (1.4)
16.0 (2.6)
18.0 (1.4)
17.3 (1.3)
13.9 (3.3)
20.8 (3.5)
20.0 (3.7)
9.1 (3.2)
10.4 (2.0)
10.2 (1.6)
28.5 (3.5)
41.2 (3.7)
35.3 (3.5)
?1
?1
?1
55.2 (13.4) 51.4 (10.9)
40.5 (6.1)
42.8 (5.6)
68.8 (6.9)
63.2 (6.0)
Abbreviation: SHCN, special health care needs.
*Data source: 2000 Medical Expenditure Panel Survey; data given in US dollars (SE), unless otherwise indicated.
†Includes expenses for facility and separately billing physician. Hospital facility expenses include all expenses for direct hospital care, including room and
board, diagnostic and laboratory work, radiography, and similar charges, as well as any physician services included in the hospital charge. Separately billing
physician expenses typically cover services provided to patients in hospital settings by providers like radiologists, anesthesiologists, and pathologists, whose
charges are often not included in hospital bills.
‡Includes expenses for office-based and hospital outpatient visits to physicians. Expenses for hospital outpatient visits include expenses of facility and
separately billing physician.
§Includes expenses for office-based and hospital outpatient visits to nonphysicians, such as chiropractors, midwives, nurses and nurse practitioner,
optometrists, podiatrists, physician’s assistants, physical therapists, occupational therapists, psychologists, social workers, technicians, receptionists/clerks/
secretaries, or other medical providers.
?Includes expenses for vision aids, other medical supplies, and equipment.
¶?2Test significant at the .05 level when comparing children with and without special health care needs.
#?2Test significant at the 0.01 level when comparing children with and without special health care needs.
(REPRINTED) ARCH PEDIATR ADOLESC MED/VOL 159, JAN 2005WWW.ARCHPEDIATRICS.COM
14
©2005 American Medical Association. All rights reserved.
at Univ of Colorado Hlth Sci Ctr, on October 18, 2006 www.archpediatrics.com Downloaded from