Children with Medicaid insurance who spend the most on health care do so largely on hospital stays, mental health services and specialty care, according to a new study.
Meanwhile, those who spend the least are using primary care, dental care and emergency departments (EDs).
The results are published in the report A Comparison of Health Care Spending and Utilization Among Children with Medicaid Insurance (Kuo DZ, et al. Pediatrics. Nov. 16, 2015, www.pediatrics.org/cgi/doi/10.1542/peds.2015-0871).
Researchers aimed to understand how Medicaid dollars are being spent to look for ways to cut costs. They analyzed 2012 data for 3.59 million children from 10 states and grouped them into four spending groups, each representing about a quarter of total spending. At one end of the spectrum, the low resource utilizers (LRUs) were made up of the least expensive 80% of children on Medicaid while at the other end, the high resource utilizers (HRUs) represented the top 1% and often had chronic conditions.
The study found that across all four groups, hospital care accounted for 22.1% of total spending, the largest of any type of care. It was followed by mental health care at 20.5% and specialty care at 9.8%.
The type of spending varied significantly among groups. For instance, inpatient hospital care made up about 46% of spending for the HRUs and less than 1% of spending for LRUs. Mental health care represented 23.9% of spending by HRUs and just under 7% of spending for LRUs.
However, the LRUs spent a greater percentage on ED services (14.8%), while these services made up just under 1% of HRU spending. Similarly, the LRUs spent 22.5% on primary care, while the HRUs spent 0.5%.
The researchers found about 20% of the HRUs did not visit a primary care physician and about half used the hospital or ED.
“Further studies should assess whether more spending on primary care — or other outpatient and community care — leads to better quality of care and cost containment for some high resource users,” the study said.
Opportunities to reduce spending in this group may lie in mental health services, according to the report. Roughly 71% of the children in the HRU group used mental health services, and the median number of encounters among users was 155.
