Background. Children with attention-deficit/hyperactivity disorder and asthma incur similar health care costs that are greater than those of most children without these conditions. Preliminary findings suggest that children with emotional behavioral disorders, anxiety and depression, incur even greater costs.Objective. To determine if children with behavioral disorders have similar health services expenditures as children with physical conditions and to assess whether children with emotional behavioral disorders incur greater expenditures than children with disruptive behavioral disorders.Methods. Children 2 to 18 years old who were members of households participating in the 1996 Medical Expenditure Panel Survey were eligible for this retrospective cohort study. Children with common behavioral disorders selected a priori were identified by using truncated International Classification of Diseases (Ninth Revision) codes obtained from household interviews. Children with common physical conditions (asthma, epilepsy, and diabetes) and children without these conditions served as controls. Estimates were weighted to reflect the complex sampling scheme. Expenditures for health services were compared.Results. Of 3955 eligible children weighted to represent 44 million, 7.1% were identified with a behavioral disorder: 4.5% with disruptive disorders; 2.1% with emotional disorders; and 0.5% with miscellaneous disorders. Children with behavioral disorders incurred overall expenditures similar to children with physical conditions (adjusted $1492 vs $1245; P = .18) but greater than children without these conditions (adjusted $1492 vs $834; P = .001). Children with behavioral disorders had greater expenditures for office-based visits (adjusted $410; 95% confidence interval: $146–672) and prescription medications (adjusted $361; 95% confidence interval: $72–648) than those of children in either control group. Among children with behavioral disorders, children with emotional disorders incurred substantially greater overall expenditures (adjusted $2152 vs $1026; P = .003) than children with disruptive disorders. Children with emotional disorders incurred greater hospitalization expenditures ($664 vs $43; P = .01) but lower pharmacy expenditures ($154 vs $307; P = .001) than children with disruptive disorders.Conclusions. In this nationally representative sample, children with behavioral disorders incurred overall health care costs similar to children with physical conditions but greater than children without any of these conditions because of increased costs for office-based visits and prescription medications. However, costs were not uniform among children with behavioral disorders. Children with emotional disorders incurred twofold higher costs than children with disruptive disorders. Greater recognition of children with emotional disorders and efforts to address the high rate of hospitalizations in this population are warranted.
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机译：背景。患有注意力缺陷/多动障碍和哮喘的儿童所承受的医疗保健费用要比没有这些疾病的大多数儿童要高。初步发现表明，患有情绪行为障碍，焦虑和抑郁的儿童会付出更高的代价。为了确定行为障碍儿童的健康服务支出是否与身体状况相似的儿童相似，并评估情绪行为障碍儿童是否比破坏性行为障碍儿童产生更大的支出。参加1996年医疗支出小组调查的家庭成员中的2至18岁儿童有资格参加这项回顾性队列研究。通过使用从家庭访谈中截取的国际疾病分类标准（第九修订版），来确定先验选择的常见行为障碍儿童。患有常见身体状况（哮喘，癫痫和糖尿病）的儿童和没有这些状况的儿童作为对照。加权估计以反映复杂的抽样方案。比较了卫生服务支出。结果。在3955名合格的儿童中，这些儿童的体重超过4400万，其中有7.1％的人患有行为障碍：4.5％的人患有破坏性疾病; 2.1％有情绪障碍; 0.5％患有其他疾病。行为障碍儿童的总支出与身体状况相似的儿童（调整后的$ 1492 vs $ 1245; P = .18）相比，在没有这些状况的情况下的儿童总支出更大（调整后的$ 1492 vs $ 834; P = .001）。行为失常儿童的住院费用（调整后的$ 410; 95％的置信区间：$ 146–672）和处方药（调整后的$ 361; 95％的置信区间：$ 72–648）比对照组的孩子要多。在行为障碍儿童中，情绪障碍儿童的总支出要比破坏性障碍儿童大得多（调整后的支出$ 2152 vs $ 1026; P = .003）。患有情感障碍的儿童比患有破坏性疾病的儿童住院费用更高（$ 664 vs $ 43; P = .01），但药房费用较低（$ 154 vs $ 307; P = .001）。在这个全国代表性的样本中，行为失常儿童的总体医疗保健费用与身体状况相似的儿童相似，但比没有任何这些状况的儿童要高得多，这是因为基于办公室的就诊和处方药的费用增加了。但是，行为障碍儿童的费用并不一致。患有情感障碍的儿童所产生的费用比具有破坏性障碍的儿童高出两倍。有必要对患有情绪障碍的儿童给予更大的认可，并努力解决这一人群的高住院率。
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