title: Health care utilization and expenditures associated with child care attendance: a nationally representative sample.
abstract: OBJECTIVE
  Participation in center-based child care among preschool-aged children is associated with an increased incidence of communicable illness. Although estimates of health care utilization and costs associated with child care attendance exist in other countries with different health care systems, nationally representative data for the United States are lacking. The objective of this study was to determine the patterns of health care utilization and costs associated with attendance at different types of child care, among a nationally representative sample of preschool-aged children.
  
  
  METHODS
  A nationally representative sample of children aged 0 to 5 years enrolled in the Medical Expenditure Panel Survey, 1997 Cohort were studied. Data were analyzed by cross-sectional analysis within a single calendar year. The Rand Health Insurance experiment 2-part multivariate regression model was used to accommodate skewed expenditure data.
  
  
  RESULTS
  A total of 871 children were included in the study. A total of 484 (56%) attended no child care provided by anyone other than their primary caregiver; 134 (15%) attended center-based child care; 76 (9%) attended friend or neighbor care; and 170 (20%) attended in-home or relative care. In a weighted multivariate model, children in center-based child care were more likely than those not in child care to have attended at least 1 office-based visit (adjusted odds ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.0-7.9) and emergency department visit (aOR: 2.0; 95% CI: 1.1-3.6) and to have received a medication prescription (aOR: 2.8; 95% CI: 1.2-6.1). The adjusted 2-part model predicted total health care expenditures for those not attending child care to be 642 dollars (95% CI: 508-813), versus 985 dollars (95% CI: 714-1336) for a similar population in center-based child care. Expenditure data for office-based visits and medication prescriptions mirrored these trends.
  
  
  CONCLUSIONS
  In the immediate term, children in center-based child care tend to use more health care services. This increased utilization translates into modest per-child differences in health care expenditures. We hypothesize that this pattern of utilization and expenditure is attributable primarily to a higher incidence of minor, self-limited, communicable illness among children in center-based child care.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle, Washington 98195, USA. msilve@u.washington.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sales
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
mesh_terms: D002654:Child Care / Q000191:economics* / Q000706:statistics & numerical data*; D002656:Child Day Care Centers / Q000191:economics* / Q000706:statistics & numerical data*; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D015999:Multivariate Analysis; D012015:Reference Standards; D012959:Socioeconomic Factors; D014481:United States