Trends in Health Care Use and Spending for Young Children With Neurologic Impairment

Pediatrics. 2022 Jan 1;149(1):e2021050905. doi: 10.1542/peds.2021-050905.


Background and objectives: Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life.

Methods: This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009-2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively.

Results: During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0-5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year.

Conclusions: For children with early-onset NI from 0-5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.

MeSH terms

  • Ambulatory Care / statistics & numerical data*
  • Child Health Services / statistics & numerical data
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data*
  • Facilities and Services Utilization
  • Female
  • Home Care Services / statistics & numerical data
  • Hospitalization / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Medicaid
  • Mental Health Services / statistics & numerical data
  • Nervous System Diseases / therapy*
  • Primary Health Care / statistics & numerical data
  • Retrospective Studies
  • United States