Medical Expenditures for US Children with Sickle Cell Disease: Impact of Payer and Health Plan Type

We present multistate, multiple health plan estimates of medical care expenditures incurred by privately and publicly insured US children with sickle cell disease (SCD). We used a private health insurance claims database and Medicaid claims databases for 2005 to estimate inpatient, outpatient, and medications used by children with SCD. The final samples consisted of 2,428 Medicaid-enrolled and 621 privately insured children with SCD who were continuously enrolled during 2005. We categorized health plans into two types: capitated and fee-for-service (FFS). The Medicaid sample consisted of 487 children in FFS plans and 1,942 in capitated plans. The Commercial sample consisted of 402 children in FFS plans and 219 in capitated plans. Medicaid-enrolled children with SCD had higher utilization of inpatient and emergency department services but had lower expenditures, as a result of lower payments. Overall mean expenditures were $11,075 and $14,722 for the Medicaid and Commercial samples. Within each payer type, mean expenditures were lower for capitated plans. For Medicaid children, mean expenditures were $12,621 for those in FFS plans and $10,845 for those in capitated plans. For privately insured children, mean expenditures were $15,844 and $12,726, respectively. Previous analyses of medical expenditures for specific conditions using claims data have typically been restricted to private FFS plans, in part because reporting of services may be more complete in FFS plans. We find similar utilization rates by plan type. The implications of the differences in reported expenditures across payer and plan types will be discussed.