Children who are medically fragile in North Carolina: using Medicaid data to estimate prevalence and medical care costs in 2004.
OBJECTIVE
The purpose of this paper is to demonstrate a method of using medical insurance paid claims and enrollment data to estimate the prevalence of selected health conditions in a population and to profile associated medical care costs. The examples presented here use North Carolina Medicaid data to produce estimates for children ages 0-19 who are medically fragile. These children with serious health conditions are a small subset of all children with special health care needs.


METHODS
The children who are medically fragile were identified through selected procedure and durable medical equipment codes. We profiled the expenditures for all medical services provided to these children during 2004.


RESULTS
1,914 children ages 0-19 enrolled in Medicaid were identified as medically fragile (0.22 percent). The amount paid by Medicaid for these children during 2004 for all medical services was $133.8 million, or $69,906 per child. By comparison, the average expenditure by Medicaid during 2004 for a randomly selected group of children receiving well-child care visits was $3,181 per child. The $133.8 million of Medicaid expenditures for the children who are medically fragile represents 6.8 percent of the nearly $2 billion spent by Medicaid in 2004 for all medical services for all children ages 0-19.


CONCLUSIONS
This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.
Buescher
Paul A
PA
State Center for Health Statistics, North Carolina Division of Public Health, 1908 Mail Service Center, Raleigh, NC 27699-1908, USA. paul.buescher@ncmail.net
Whitmire
J Timothy
JT
Brunssen
Susan
S
Kluttz-Hile
Catherine E
CE
D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D039702:Current Procedural Terminology; D019988:Children with Disabilities; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D009657:North Carolina