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Behavioral health spending spikes to 40% of all children’s health expenditures, nearly doubling in a decade
New study reveals dramatic increase in pediatric behavioral health expenditures while families face mounting out-of-pocket costs
Ann & Robert H. Lurie Children's Hospital of Chicago
Behavioral health care has surged to represent 40% of all medical expenditures for U.S. children in 2022, nearly doubling from 22% in 2011, according to a new study published in JAMA Pediatrics. Researchers found that pediatric behavioral health expenditures totaled $41.8 billion in 2022, with families paying $2.9 billion out-of-pocket. Most concerning, out-of-pocket costs for children's behavioral health increased at more than twice the rate of other medical expenses, leaving many families struggling with significant financial burden.
The study analyzed data on nationally representative spending patterns for U.S. children ages 6-17 from 2011 to 2022. Researchers found that pediatric behavioral health out-of-pocket spending increased 6.4% annually, compared to 2.7% annually for non-behavioral health medical spending. By 2022, more than one-quarter of total pediatric out-of-pocket spending for health care was directed toward behavioral health.
“We were surprised by the magnitude of spending for children’s behavioral health, and especially the dramatically rising out-of-pocket costs for families,” said senior author Kenneth Michelson, MD, MPH, emergency medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “Our findings provide a striking perspective on the youth behavioral health crisis.”
The financial impact on families is substantial. The study found that 1 in 21 U.S. families experiences extreme financial burden due to out-of-pocket health care costs, meaning that more than 10% of family income is allocated towards those costs. Families with at least one child receiving behavioral health services were about 40% more likely to experience extreme financial burden.
“Many families are forced to seek care outside of their insurance network, facing higher out-of-pocket costs for their children’s behavioral health care. Our findings underscore the critical need for adequate networks and improved insurance coverage to reduce the financial burden on families,” said co-author Jennifer Hoffmann, MD, MS, emergency medicine physician at Lurie Children’s and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “We need stronger state-level insurance parity laws, meaning equal insurance coverage for behavioral and non-behavioral health care.”
The study also revealed significant shifts in how and where children receive behavioral health care. Expenditures increased dramatically for home health care (25% per year), outpatient in-person visits (11% per year), and outpatient telehealth visits (99% per year from 2020-2022).
“Telehealth rapidly expanded during the pandemic and is likely to remain a lasting component of behavioral health delivery in the U.S.,” said Dr. Hoffmann. “However, gaps in funding for telehealth remain. Better reimbursement rates are needed. Regulations also need to be adjusted to enable children to access telehealth across state lines.”
Ann & Robert H. Lurie Children’s Hospital of Chicago is a nonprofit organization committed to providing access to exceptional care for every child. It is the only independent, research-driven children’s hospital in Illinois and one of less than 35 nationally. This is where the top doctors go to train, practice pediatric medicine, teach, advocate, research and stay up to date on the latest treatments. Exclusively focused on children, all Lurie Children’s resources are devoted to serving their needs. Research at Lurie Children’s is conducted through Stanley Manne Children’s Research Institute, which is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is the pediatric training ground for Northwestern University Feinberg School of Medicine. It is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. Emergency medicine-focused research at Lurie Children’s is conducted through the Grainger Research Program in Pediatric Emergency Medicine.
Journal
JAMA Pediatrics
Kids’ behavioral health is a growing
share of family health costs
Mental health, substance use, and other behavioral health care made up 40% of all health expenditures for U.S. children in 2022, according to a new study by researchers at UC San Francisco. That is almost twice what it was in 2011.
The costs to families for this type of care grew more than twice as fast as the costs for other types of medical care. Out-of-pocket spending on behavioral health rose an average of 6.4% each year for families, compared with 2.7% for non-behavioral health care.
“Families are bearing growing costs,” said Ashley Foster, MD, lead author of the study, which appears Dec. 15 in JAMA Pediatrics, and a pediatric emergency care physician at UCSF Benioff Children’s Hospitals. “As a country, we need to make sure behavioral health care is accessible and affordable for every family, regardless of insurance status.”
The researchers reviewed 11 years of national spending data from 2011 through 2022 for children between the ages of 6 and 17. By 2022, behavioral health accounted for $41.8 billion of overall health spending, and families were paying $2.9 billion — more than a quarter of their out of pocket health spending — for this type of care.
Having a child who needs behavioral health care increases a family’s risk of financial hardship.
“Families with at least one child who has behavioral health issues are 60% more likely to face a high financial burden, and 40% more likely to have an extreme financial burden — meaning more than 10% of their family income goes toward that care,” Foster said.
While the study wasn’t designed to investigate causes for the rise in spending, there are some clues in the data.
“It’s likely a combination of a few factors: more children having behavioral health challenges, in part due to the COVID-19 pandemic; a rise in costs per visit over time; and an increase in access to care,” Foster said. “Access has improved thanks to less stigma about mental health challenges and because there are more community-based care venues now.”
The research also revealed shifts in how and where children receive behavioral health treatment. Spending jumped 25% per year for home health services and 11% per year for in-person outpatient visits. The number of telehealth visits spiked 99% per year between 2020 and 2022. “Telehealth is here to stay,” said Foster.
Journal: JAMA Pediatrics
Co-Authors: Please see the paper.
Funding and Disclosures: None to disclose.
Journal
JAMA Pediatrics
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