For a number of years, we’ve seen overall health care spending increasing at a slower rate than in the years before. But one of the things that frustrates me about these types of reports is that they rarely focus on children.
One of the things that’s drummed into the mind of every pediatric trainee is that “children are not little adults.” We cannot assume that we understand kids and health by taking what we know about adults and just shrinking it. This is true with spending as well.
The Health Care Cost Institute recently released a report entitled Children's Health Spending: 2009-2012 that provides us with a lot of specific information in this area. Let’s start with the fact that health care spending per child age 18 years of age or less was $2437 in 2012. This was a $363 increase from 2009, for an average growth of about 5.5% per year.
This growth remains higher than that seen in adults. But there’s still a lot of room for movement. The amount we spend per child is less than a third of what we spend on every adult.
Spending varies greatly by age as well. Infants and toddlers up to age three cost $4446 each, which is about half of what we spend on adults. The vast majority of spending in this age group is on inpatient hospitalizations and professional procedures.
Children age 4-8 years, on the other hand, cost $1653 each, making them really cheap. Prescriptions constitute a larger share of spending, especially those treating infectious diseases and central nervous system disorders.
In general, each child spends 54.6 days each year covered by a generic drug prescription, and another 19.5 days covered by a brand name drug prescription.
I’m not going to spend too much more time reporting results, because you can go read the report for yourself. But there are a few points I’d like to highlight. The first is that it’s easy to see that much like we can’t treat children as adults, we also can’t treat all children the same. Infants and toddlers are not like elementary school children. And they aren’t like preteens or teenagers. Each group has different needs, and different drivers of spending.
Children don’t constitute a huge part of health care spending. But they do constitute a large part of Medicaid. And as children’s health care spending increases, Medicaid spending will follow. That’s a real concern to state governments, and to the federal government as well.
Finally, the last page of the report details this:
In 2010, children’s outpatient visits to emergency rooms (ERs) declined, with the most pronounced declines for younger children. ER visits per 1,000 children fell by 9.4 percent for preteens, 8.2 percent infants and toddlers (Table A6), and 6.5 percent for teens. In 2011, children’s visits to the ER rose, increasing 1.8 percent for infants and toddlers, 5.2 percent for younger children, 2.0 percent for pre-teens, and 1.8 percent for teens. However, by 2012, visits to the ER for all children remained below 2009 levels.
It’s not like children’s health vastly improved over this time such that they didn’t need as much care. One of the possible reasons for this was a delayed effect of the recession. In other words, some children might not have received care because of cost. We can’t know at this time whether this affected the quality of children’s health care or health, but it bears watching in the future.