Children who are medically fragile in North Carolina : prevalence and medical care costs in 2002

rjt^c North Carolina Public Health SCHS Studies A Special Report Series by the State Center for Health Statistics 1908 Mail Service Center, Raleigh, N.C. 27699-1908 www.schs.state.nc.us/SCHS/ No. 147 February 2005 Children Who Are Medically Fragile in North Carolina: Prevalence and Medical Care Costs in 2002 by Paul A. Buescher, Ph.D. J. Timothy Whitmire, Ph.D. Susan Brunssen, Ph.D., R.N. Deborah Nelson, Ph.D., M.S.P.H. Eleanor E. Howell, M.S. Stat. Catherine E. Kluttz-Hile, B.S.N., M.A. ABSTRACT Objectives: Children with serious and complicated medical conditions often require intensive medical treat¬ ment and have very high medical care costs. This study estimates the total number of children in North Caro¬ lina of pre-school age who are medically fragile and profiles their medical care costs. Some of these children might be appropriately placed in a medical child care environment as a means of improving their health and reducing hospital and emergency room use. Methods: Inpatient hospital discharge and Medicaid paid claims data for 2002 were used to estimate preva¬ lence and medical care costs. The children who are medically fragile were identified through selected proce¬ dure and durable medical equipment codes. Using the Medicaid data, we profiled the expenditures for all medical services provided to these children during 2002, not just hospitalizations. Results: From the hospital discharge data, 1,811 children ages 0-4 years in North Carolina were identified as medically fragile (0.32%). The hospital charges for these children during 2002 were $109.4 million, or $60,409 per child. From the Medicaid data, 1,126 children enrolled in Medicaid were identified as medically fragile (0.44%). The total amount paid by Medicaid for these children during 2002 (for all medical services, not just hospitalizations) was $82.9 million, or $73,669 per child. By comparison, the average expenditure by Medic¬ aid during 2002 for a randomly selected group of children receiving well-child visits was $2,016 per child. The $82.9 million of Medicaid expenditures for the children who are medically fragile represents 14 percent of the $598 million spent by Medicaid in 2002 for all medical services for all children ages 0-4. Conclusions: A small number of children who tire medically fragile use a large amount of medical care ser¬ vices. Medical child care facilities could provide some of these children with the necessary care that they need during the work day, allow parents to return to work, and provide families with the emotional and physi¬ cal break that they need to cope with the high demands that come with the care of their child. Also, these facilities can help medical care systems, such as Medicaid, to better manage health care costs, particularly by reducing hospital and emergency room use. * NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES