Health Care Use and Spending of Pediatric Patients With an Intellectual or Developmental Disability.

Background: Health care costs and utilization for those with an intellectual or developmental disability (IDD) have been shown to be higher than the general population. Objective: To investigate the services that contribute to higher costs and utilization among noninstitutionalized children with an IDD. Design: Matched case-control secondary analysis of the 2000-2017 Medical Expenditure Panel Survey. Pediatric (age 0-21) patients with an IDD were matched to non-IDD subjects. Health care utilization and costs were evaluated with zero-inflated negative binomial regressions and generalized linear models, respectively. Measures: Outcome measures included high-acuity health care utilization [ie, emergency department (ED) visits and hospital admissions], and cost outcomes for total spending, ED use, hospitalization, medications, office visits, home health, and physical therapy. Results: There was no statistical difference in utilization of EDs among the 2 groups though subjects with an IDD showed more hospitalizations than their matched cohort (incidence rate ratios=1.63, P=0.00). Total health care spending was higher among patients with an IDD (coefficient=$5831, P=0.00). Pediatric spending was higher in all measures except for ED. The biggest discrepancies in spending were seen in home health (coefficient=$2558, P=0.00) and outpatient visits (coefficient=$1180, P=0.00). Conclusions: Pediatric patients with an IDD had higher health care spending and utilization than non-IDD subjects in all categories except for ED use.