Spending on Children's Personal Health Care in the United States, 1996–2013

Published in: JAMA Pediatr. 2017;171(2):181-189. doi:10.1001/jamapediatrics.2016.4086

Posted on RAND.org on March 28, 2016

by Anthony L. Bui, Joseph L. Dieleman, Hannah Hamavid, Maxwell Birger, Abigail Chapin, Herbert C Duber, Cody Horst, Alex Reynolds, Ellen Squires, Paul J. Chung, Christopher J. Murray

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Research Questions

  1. How much money was spent on children's health care from 1996 to 2013?
  2. What trends emerge when looking at spending across all types of payers?

Importance

Health care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time.

Objective

To provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care.

Evidence Review

Health care spending estimates were extracted from the Institute for Health Metrics and Evaluation Disease Expenditure 2013 project database. This project, based on 183 sources of data and 2.9 billion patient records, disaggregated health care spending in the United States by condition, age and sex group, and type of care. Annual estimates were produced for each year from 1996 through 2013. Estimates were adjusted for the presence of comorbidities and are reported using inflation-adjusted 2015 US dollars.

Findings

From 1996 to 2013, health care spending on children increased from $149.6 (uncertainty interval [UI], 144.1-155.5) billion to $233.5 (UI, 226.9-239.8) billion. In 2013, the largest health condition leading to health care spending for children was well-newborn care in the inpatient setting. Attention-deficit/hyperactivity disorder and well-dental care (including dental check-ups and orthodontia) were the second and third largest conditions, respectively. Spending per child was greatest for infants younger than 1 year, at $11741 (UI, 10 799-12 765) in 2013. Across time, health care spending per child increased from $1915 (UI, 1845-1991) in 1996 to $2777 (UI, 2698-2851) in 2013. The greatest areas of growth in spending in absolute terms were ambulatory care among all types of care and inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma among all conditions.

Conclusions and Relevance

These findings provide health policy makers and health care professionals with evidence to help guide future spending. Some conditions, such as attention-deficit/hyperactivity disorder and inpatient well-newborn care, had larger health care spending growth rates than other conditions.

Key Findings

  • This study combined 183 data sources to compile spending estimates for 150 conditions, disaggregated by age, sex, and type of care, for the period 1996 to 2013.
  • Annual health care spending on children's care grew overall by 56.2 percent, driven by spending growth in ambulatory, inpatient, well-newborn, and attention-deficit/hyperactivity disorder (ADHD).
  • The categories of care with the largest amount of spending in 2013 were well-newborn care, ADHD, and well-dental care.
  • Policymakers can use the data on spending and changes in spending to discern health system patterns and address needs that are found.

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