Care Quality and Spending Among Commercially Insured Children With Disabilities

Acad Pediatr. 2019 Apr;19(3):291-299. doi: 10.1016/j.acap.2018.06.004. Epub 2018 Jun 19.


Objective: To identify opportunities to improve care value for children with disabilities (CWD), we examined CWD prevalence within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions.

Methods: This cross-sectional study comprised 1,118,081 person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged 1 to 19years old during 2008 to 2012. We combined the newly developed and validated Children with Disabilities Algorithm with the Pediatric Medical Complexity Algorithm to identify CWD and non-CWD subgroups. We used 14 validated or National Quality Forum-endorsed measures to assess outpatient care quality and paid claims to examine annual plan spending levels and components.

Results: CWD constituted 4.5% of all enrollees. Care quality for CWD was between 11% and 59% for 8 of 14 quality measures and >80% for the 6 remaining measures and was generally comparable to that for non-CWD subgroups. Annual plan spending among CWD was a median and mean 23% and 53% higher than that for children with complex medical conditions without disabilities, respectively; CWD mean and median values were higher than for all other groups as well.

Conclusions: CWD were prevalent in our commercially insured population. CWD experienced suboptimal levels of care, but those levels were comparable to non-CWD groups. Improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.

Keywords: children with disabilities; quality; spending.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Ambulatory Care / economics
  • Ambulatory Care / standards*
  • Case-Control Studies
  • Child
  • Child Health Services / economics
  • Child Health Services / standards*
  • Child, Preschool
  • Disabled Children*
  • Female
  • Health Expenditures*
  • Humans
  • Infant
  • Insurance, Health*
  • Male
  • Pediatrics
  • Quality of Health Care*
  • Young Adult