title: Health Care Utilization and Costs of Publicly-Insured Children with Diabetes in California.
abstract: OBJECTIVE
  To examine diabetes-related health care utilization and costs for a population-based sample of children with presumed type 1 diabetes (T1D) enrolled in the California Children's Services program.
  
  
  METHODS
  Our data source was the California Children's Services claims data for the period July 1, 2009, to June 30, 2012. We studied a sample of 652 children aged 0-21 years who were continuously enrolled for at least 365 days, had an outpatient visit for T1D, and were taking insulin.
  
  
  RESULTS
  Compared with the younger age groups, individuals in the 19-21 year age group had the highest rates of hospitalization, T1D-specific bed-days, and emergency department visits. The overall median cost for this population was $7654. The overall median costs per year (and proportion of total costs) were $5603 (59%) for hospitalizations, $58 (0.4%) for emergency department visits, $144 (1.3%) for outpatient utilization, $2930 (23%) for insulin, and $1579 (13%) for blood glucose monitoring supplies. For those who used them, the median cost of pumps was an additional $2162.
  
  
  CONCLUSIONS
  Further studies are needed to provide more insight into patterns of care and adverse health outcomes for children with T1D as they transition into young adulthood. The costs of insulin, glucose monitoring supplies, and pump therapy for children with T1D is substantial and may factor into future policy considerations regarding coverage and cost-sharing with families.
authors.affiliation: Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI; Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI. Electronic address: joyclee@umich.edu.
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA.
authors.forename: Vandana
authors.initials: V
authors.lastname: Sundaram
authors.affiliation: Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA.
authors.forename: Lee
authors.initials: L
authors.lastname: Sanders
authors.affiliation: Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Chamberlain
authors.affiliation: Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA.
authors.forename: Paul
authors.initials: P
authors.lastname: Wise
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000191:economics* / Q000208:ethnology / Q000628:therapy*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007332:Insulin Infusion Systems / Q000191:economics; D008297:Male; D008483:Medical Assistance; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult