title: Health-care use and expenditures for children in special education with special health-care needs: is dual classification a marker for high use?
abstract: OBJECTIVE
  Children with special health-care needs are an important group for policy and research planning. Special education engages a group of children with increased utilization of services related to education. While increased service utilization in education or health-care settings is often used to classify children as having special needs, considerable heterogeneity exists within each group. The extent to which being identified in two functionally defined systems--special education and health care--relates to health-care utilization is unknown. We sought to determine health-care and mental health utilization and expenditures for children dually classified as receiving special education and having special health-care needs (SHCN) compared with those who only have SHCN, only are in special education, or don't fall into either category.
  
  
  METHODS
  A nationally representative sample of children aged 5-17 years from the Medical Expenditure Panel Survey was used to compare mean health-care and mental health utilization and expenditures for the four groups.
  
  
  RESULTS
  Dually classified children had significantly higher mean utilization of health-care services than the other three groups (p < 0.05). Mean 12-month total health-care expenditures were highest for dually classified children ($3,891/year) (p < 0.05) and higher for children classified only as having SHCN ($1,426/year) than for children with neither classification ($644/year, p < 0.05).
  
  
  CONCLUSIONS
  Children dually classified as receiving special education and having SHCN represent a subgroup of children with SHCN with high levels of health-care utilization and expenditures. This information can assist policy makers in identifying characteristics that place children at risk for very high expenditures, and in allocating health-care resources.
authors.affiliation: Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA. Laura.Sices@UHhospitals.org
authors.forename: Laura
authors.initials: L
authors.lastname: Sices
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Harman
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Kelleher
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D004519:Education, Special; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*