title: Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance.
abstract: OBJECTIVE
  Opportunities to improve health care quality and contain spending may differ between high and low resource users. This study's objectives were to assess health care and spending among children with Medicaid insurance by their resource use.
  
  
  METHODS
  Retrospective cross-sectional analysis of 2012 Medicaid health administrative data from 10 states of children ages 11 months to 18 years. Subjects were categorized into 4 spending groups, each representing ∼25% of total spending: the least expensive 80% of children (n = 2,868,267), the next 15% expensive (n = 537,800), the next 4% expensive (n = 143,413), and the top 1% (n = 35,853). We compared per-member-per-month (PMPM) spending across the groups using the Kruskal-Wallis test.
  
  
  RESULTS
  PMPM spending was $68 (least expensive 80%), $349 (next 15%), $1200 (next 4%), and $6738 (top 1%). Between the least and most expensive groups, percentages of total spending were higher for inpatient (<1% vs 46%) and mental health (7% vs 24%) but lower for emergency (15% vs 1%) and primary (23% vs 1%) care (all Ps < .001). From the least to most expensive groups, increases in PMPM spending were smallest for primary care (from $15 to $33) and much larger for inpatient ($0.28 to $3129), mental health ($4 to $1609), specialty care ($8 to $768), and pharmacy ($4 to $699).
  
  
  CONCLUSIONS
  As resource use increases in children with Medicaid, spending rises unevenly across health services: Spending on primary care rises modestly compared with other health services. Future studies should assess whether more spending on primary care leads to better quality and cost containment for high resource users.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Hospital Research Institute, Little Rock, Arkansas;
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.affiliation: Children's Hospital Association, Overland Park, Kansas;
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Division of Hospital-Based Medicine, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
authors.forename: Rishi
authors.initials: R
authors.lastname: Agrawal
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.affiliation: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
authors.forename: Denise M
authors.initials: DM
authors.lastname: Goodman
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington;
authors.forename: John M
authors.initials: JM
authors.lastname: Neff
authors.affiliation: Division of General Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States