Children are using health services less—but medical costs still rising: Study

Kids are going to the doctor's office and emergency rooms less often, and even using fewer prescription drugs — but overall health spending on children is still going up.

A study released Monday by the Health Care Cost Institute indicates that price increases for health services and brand-name drugs were the biggest drivers of higher overall medical spending on kids from 2010 through 2014.

During that time period, per capita spending on health care for children covered by job-based insurance plans grew at an annual average rate of 5.1 percent, rising from $2,356 per child in 2010 to $2,660 per kid by 2014, HCCI said. By comparison, the overall spending on persons under the age of 65 in 2014 was $4,967 per person, according to HCCI.

Out-of-pocket health spending — money that has to be personally paid, instead of by an insurance plan — on health care for children grew by an annual average percentage of 5.5 percent during the same time frame, starting at $381 per capita in 2010 and ending at $472 per child in 2014.

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Brand-name drug prices during that time period more than doubled in price, from an average of $7 per filled prescription day to $16 per day — even as usage of brand-name prescriptions by kids dropped by almost 50 percent.

Spending on generic drugs remained stable during the time period, at $2 per filled prescription day.

At the same time, the average price for surgical admissions for a child skyrocketed by $35,423 per kid to $53,372 by 2014, an increase of more than 50 percent.

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The findings, based on data for more than 10 million children, raise the question of whether increasing prices are helping to drive down overall health-care usage by children.

"If spending is going up, and price is going up, but use is going down, it is a reasonable question to know why that is, and are we getting the outcomes in health that we want to be getting," said Amanda Frost, HCCI's senior researcher.

Frost said the data HCCI examined do not reveal why children are using fewer services.

"We should be asking, 'Why are kids using fewer services, why are they going to the ER less, why are they going to the doctor less, why are they using fewer prescription drugs and are we getting desirable health outcomes?'" she said.

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The study's findings echo an HCCI report last year that found that overall health spending per capita on adults was growing even as use of medical services decreased.

Frost said the data released Monday indicate that kids started using fewer types of certain health services around 2011.

But "2014 is where we really see declines across the board," she said.

That year saw visits to doctors, the most common service for kids, as well as to radiology services and surgery services, drop by 0.4 percent from 2013. But spending on such visits in 2014 grew by 3.5 percent, HCCI's study shows.

Outpatient visits by children shrank by 2 percent in 2014, but spending on such visits grew by 6.4 percent, according to HCCI.

And while the number of acute inpatient cases stayed about the same time, spending on them grew by 3.1 percent in 2014, the study found.

Emergency room visits dropped from 181 per 1,000 children in 2010 to 177 visits by 2014. But spending per capita on children for ER visits grew from $165 per capita in 2010 to $214 per capita by 2014.

And the average price of an ER visit increased by $298 over that time frame.