TOPLINE:

Pediatric behavioral health expenditures in the US totaled $41.8 billion in 2022, nearly doubling from 22.4% to 40.2% of all child health spending over the past decade. Having a child with behavioral health costs was linked to 1.6 times higher odds of high family financial burden.

METHODOLOGY:

• Analysis included 101.9 million child-years of behavioral health spending data from the Medical Expenditure Panel Survey household component files for US children aged 6-17 years from 2011 to 2022.
• Researchers evaluated behavioral healthcare expenditures through medical visits with primary behavioral health diagnoses and behavioral health prescriptions across various care venues including home health, telehealth, outpatient visits, emergency departments, and inpatient stays.
• Investigators examined the association between child behavioral health spending and high family financial burden using weighted logistic regression, adjusting for factors such as family size, income, insurance type, and region.

TAKEAWAY:

• Total pediatric behavioral health expenditures increased by $1.2 billion annually (95% CI, 0.6-1.8 billion) from 2011 to 2022, with significant increases noted in home healthcare (24.8% per year; 95% CI, 8.0%-46.7%) and outpatient in-person visits (11.0% per year; 95% CI, 8.0%-14.0%).
• Out-of-pocket behavioral health spending increased from $2.1 billion to $2.9 billion, rising by 6.4% annually (95% CI, 3.5%-9.0%), which was more than twice the rate of nonbehavioral health out-of-pocket medical spending (2.7% annually; 95% CI, 0.6%-4.8%).
• Having a child with behavioral health costs was independently associated with high family financial burden (adjusted odds ratio [AOR], 1.60; 95% CI, 1.44-1.78) and extreme financial burden (AOR, 1.42; 95% CI, 1.22-1.65).
• Families with public insurance were less likely to experience high (AOR, 0.56; 95% CI, 0.50-0.64) or extreme financial burden (AOR, 0.71; 95% CI, 0.59-0.85) compared to those with private insurance.

IN PRACTICE:

“Behavioral health spending was associated with high family financial burden, which reflects increased demand and cost for services and supports expanding access through insurance coverage and clinician availability,” the authors of the study wrote.

SOURCE:

This study was led by Ashley A. Foster, MD, Department of Emergency Medicine, University of California, San Francisco. It was published online on December 15 in JAMA Pediatrics.

LIMITATIONS:

The Medical Expenditure Panel Survey collected data based on caregiver-reported recall and diary entries, which may lead to recall bias and underestimation or overestimation of child behavioral healthcare use. Expenditures may be related to multiple conditions beyond behavioral health, and while the study included only spending associated with primary behavioral health diagnoses to minimize this effect, it may still have affected spending estimates. Additionally, out-of-pocket costs do not account for families who received reimbursement after reporting or indirect costs such as transportation and missed work.

DISCLOSURES:

Foster disclosed receiving grants from Abbott Laboratories and the Pediatric Pandemic Network outside the submitted work. Jennifer A. Hoffmann reported receiving support from the National Institute of Mental Health of the National Institutes of Health under award K23MH135206-01. Katherine A. Nash was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant KL2TROO1874. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.