Purpose: To examine utilization and charges for adolescents with special health care needs (ASHCN), adolescents engaging in risky behaviors (ARB) and both (BOTH), compared to adolescents with no identified special health care or risky behavior diagnosis (ANIC) in a pool of adolescent enrollees eligible for Title XXI services. Methods: Claims and encounter data were used to classify 11,459 adolescents who had been enrolled in Florida’s Healthy Kids Program for 2 consecutive years into 4 groups: ASHCN (n=1,363); ARB (n=1,801); BOTH (n=773); and ANIC (n=7,522). Monthly per capita inpatient, outpatient, emergency room, and total use and charges were compared across groups. Results: The data indicated that ASHCN, ARB, and BOTH consume significantly more health care services than ANIC, and that their higher use and charges are attributable not only to condition-related costs, but also to their higher use of non-condition-related services as well. The data also revealed that adolescents with a special health care diagnosis (ASHCN, BOTH) had a higher percentage of costs due to inpatient stays, whereas adolescents with a risky-behavior diagnosis (ARB, BOTH) had a higher percentage of costs due to emergency room usage. Conclusions: This study underscores two important points that can be used to ensure that adequate financing, provider network and service delivery systems are developed to best meet the needs of the adolescent population: (1) consideration of health status in the enrollee pool for reimbursement rate setting strategies; and (2) consideration of category of service utilization in setting premiums for various groups.
Learning Objectives: N/A
Keywords: Adolescent Health, Financing
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.