[Socioeconomic status and health insurance expenditures for children and adolescents with conduct disorder : An analysis of statutory health insurance data]

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019 Sep;62(9):1057-1066. doi: 10.1007/s00103-019-02991-1.
[Article in German]


Background: For various psychiatric and somatic disorders, there is evidence of an association between patients' socioeconomic status (SES), healthcare utilisation, and the resulting costs. In the field of child and adolescent psychiatric disorders, studies on this topic are lacking.

Objectives: To exploratively analyse the association of healthcare expenditures for children and adolescents with conduct disorder (including oppositional-defiant disorder) - one of the most prevalent child and adolescent psychiatric disorders - and SES.

Materials and methods: The analysis is based on routine data from the German statutory health insurance company AOK Nordost for the calendar year 2011, covering 6461 children and adolescents (age 5-18 years) with an ICD-10 diagnosis of conduct disorder. The insureds' SES was estimated indirectly, based on the social structure of the postcode area, using the German Index of Multiple Deprivation (Mecklenburg-Vorpommern, Brandenburg), and the Berliner Sozialindex I (Berlin), respectively. From the two indices, quintiles were derived. Based on these quintiles, average costs per case for the following cost types were analysed: inpatient healthcare, outpatient healthcare (general practitioners, paediatricians, child and adolescent psychiatrists, child and adolescent psychotherapists), and prescribed medication.

Results: There was no significant functional association between SES and healthcare costs for any of the analysed cost types.

Conclusions: In contrast to findings in adults, this study on children and adolescents with conduct disorders did not reveal an association between SES and healthcare costs. Within this group of patients, social inequality does not seem to have a significant influence on healthcare utilisation in Germany.

Keywords: Area deprivation; Child and adolescent psychiatry; Cost analyses; Secondary data; Service use.

MeSH terms

  • Adolescent
  • Child
  • Conduct Disorder / economics*
  • Conduct Disorder / therapy*
  • Delivery of Health Care / economics
  • Germany
  • Health Care Costs / statistics & numerical data*
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Insurance, Health*
  • Social Class*