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

Abstract

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 $11 741 (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.

Figure 1. Personal Health Care Spending in the United States by Age Group, Aggregated Condition Category, and Type of Care in 2013

Each of the 3 columns reflect the $233.5 billion of children’s health care spending disaggregated in this study. The length of each bar reflects the relative share of the $233.5 billion attributed to that age group, condition category, or type of care. Spending estimates are reported using inflation-adjusted 2015 US dollars. Communicable diseases include nutrition deficiencies. DUBE indicates diabetes, urogenital, blood, and endocrine diseases.

Figure 2. Spending per Child on Personal Health Care for Children and Adolescents in the United States by Type of Care in 2013

Health care spending per child reported using inflation-adjusted 2015 US dollars. Emergency care excludes emergency visits that resulted in an inpatient stay admission. Inpatient care includes spending in emergency departments for patients who transferred to inpatient care and includes pharmaceuticals provided while in inpatient care. Ambulatory care includes urgent care clinics and pharmaceuticals provided as part of a visit.

Figure 3. Children’s Personal Health Care Spending in the United States by Age, Sex, and Condition in 2013

Spending estimates are reported using inflation-adjusted 2015 US dollars. Increases in spending along the x-axis indicate more spending. Communicable diseases include nutrition deficiencies. DUBE indicates diabetes, urogenital, blood, and endocrine diseases.

Figure 4. Changes in Spending per Child on Personal Health Care in the United States by Condition From 1996 to 2013

Each panel reports the absolute change in spending (left) reported using inflation-adjusted 2015 US dollars and the annualized rate of change in spending (right) reported as an annualized growth rate. For all panels and axes, change is the difference in spending between 1996 and 2013. A, Changes in spending for all 7 types of care. Emergency care excludes emergency visits that resulted in an inpatient stay admission. Inpatient care includes spending in emergency departments for patients that transferred to inpatient care and includes pharmaceuticals provided to these patients. Ambulatory care includes urgent care clinics and pharmaceuticals provided as part of a visit. B, Changes for the 10 conditions with the greatest absolute increases in spending. C, Changes in spending for the 5 age groups. Error bars indicate uncertainty intervals.