Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Dec;130(6):e1463-70.
doi: 10.1542/peds.2012-0175. Epub 2012 Nov 26.

Patterns and costs of health care use of children with medical complexity

Eyal Cohen  1 , Jay G Berry, Ximena Camacho, Geoff Anderson, Walter Wodchis, Astrid Guttmann
Affiliations

Patterns and costs of health care use of children with medical complexity

Eyal Cohen et al. Pediatrics. 2012 Dec.

Abstract

Background and objective: Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada.

Methods: Hospital discharge data from 2005 through 2007 identified CMC. Complete health system use and costs were analyzed over the subsequent 2-year period.

Results: The study identified 15 771 hospitalized CMC (0.67% of children in Ontario); 10 340 (65.6%) had single-organ CCC, 1063 (6.7%) multiorgan CCC, 4368 (27.6%) neurologic impairment, and 1863 (11.8%) had TA. CMC saw a median of 13 outpatient physicians and 6 distinct subspecialists. Thirty-six percent received home care services. Thirty-day readmission varied from 12.6% (single CCC without TA) to 23.7% (multiple CCC with TA). CMC accounted for almost one-third of child health spending. Rehospitalization accounted for the largest proportion of subsequent costs (27.2%), followed by home care (11.3%) and physician services (6.0%). Home care costs were a much larger proportion of costs in children with TA. Children with multiple CCC with TA had costs 3.5 times higher than children with a single CCC without TA.

Conclusions: Although a small proportion of the population, CMC account for a substantial proportion of health care costs. CMC make multiple transitions across providers and care settings and CMC with TA have higher costs and home care use. Initiatives to improve their health outcomes and decrease costs need to focus on the entire continuum of care.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Construction of the cohort of children with CCCs and NIs with or without TA.
FIGURE 2
FIGURE 2
Cost breakdown by cohort subgroups (excluding index hospitalization). All costs expressed as mean cost (C$) per patient in each subgroup. Mult, multiple; OHIP, Ontario Health Insurance Plan (physician billing); Other, same day surgery, emergency department visits, inpatient rehabilitation and complex continuing care.
See this image and copyright information in PMC

References

    1. Gawande A. The hot spotters: can we lower medical costs by giving the neediest patients better care? New Yorker. 2011(January 24);40–51 - PubMed
    1. Zook CJ, Moore FD. High-cost users of medical care. N Engl J Med. 1980;302(18):996–1002 - PubMed
    1. van Walraven C, Dhalla IA, Bell C, et al. . Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182(6):551–557 - PMC - PubMed
    1. Berry JG, Agrawal R, Kuo DZ, et al. . Characteristics of hospitalizations for patients who use a structured clinical care program for children with medical complexity. J Pediatr. 2011;159(2):284–290 - PMC - PubMed
    1. Simon TD, Berry J, Feudtner C, et al. . Children with complex chronic conditions in inpatient hospital settings in the United States. Pediatrics. 2010;126(4):647–655 - PMC - PubMed

Publication types

MeSH terms