School
School of Public Health
Document Type
Dissertation
Department (new version)
Public Health
Date of Award
1998
Degree Name by School
Doctor of Public Health (DrPH) School of Public Health
Abstract
Objectives . (1) To identify and describe four groups of children with special health care needs (CSHCN) using definitions that represent various groups of special needs children who are, or who have been recommended to be, carved-out of participation in managed care plans. (2) To examine how total, mean, and median annual health care expenditures differ based on the definition for CSHCN used. (3) To assess the capacity of several risk adjusters, including age, gender, CSHCN group to which children belong, and the Ambulatory Diagnostic Groups (ADGs) to predict annual expenditures for healthy children and for the groups of CSHCN. Method . This study analyzed Alabama Medicaid claims data for children between the ages of 1 and 17 who were continuously enrolled in Alabama's Medicaid program throughout calendar years 1994 and 1995. Results . The prevalence of CSHCN varied from 1% to 13%, depending on the definition for CSHCN used. Combining the four groups yielded an estimate of 23% of the children in this study with special health care needs. Fifty-five percent of the expenditures for the children in this study were for CSHCN. However, some groups of CSHCN were found to have greater total, mean, and median expenditures than the others. Generally, age and gender were able to explain very little of the variation in expenditures for each of the four groups of children without special health care needs (.17%–.65%) and for each of the groups of CSHCN (.04%–1.5%). Age, gender, and the 34 ADG categories were able to explain between 6.02% and 8.72% of the variation in expenditures for each of the four groups of children without special health care needs and between 8.5% and 10.9% of the variation in expenditures for each of the four groups of CSHCN. Overall, these variables could explain 3.16% of the variation in expenditures for all children without special health care needs and 8.4% of the variation in expenditures for all children with special health care needs. Therefore, when children with special health care needs are combined with those who do not have special health care needs, the percentage of the variation in expenditures explained rose from 3.16% to 8.8%. Prediction estimates improved considerably when expenditures were truncated at $25,000. Conclusion . Prevalence and expenditure estimates for CSHCN vary, depending on the definition used. Whatever the definition, one can better risk adjust for CSHCN than for children without special health care needs using standard methods. Thus, concerns regarding the lack of predictability of expenditures for children with special health care needs that leads to carving them out of managed care plans are unfounded in this study.
ProQuest Publication Number
ProQuest ID
9949101
ISBN
978-0-599-51324-2
Recommended Citation
Risley Gupta, Kristina Yvette, "Risk adjusting and setting capitation rates for children: Including versus excluding children with special health care needs from participation in managed care arrangements" (1998). All ETDs from UAB. 7199.
https://digitalcommons.library.uab.edu/etd-collection/7199
Comments
DrPH