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首页> 外文期刊>Health services research: HSR >Profile of medical charges for children by health status group and severity level in a Washington State Health Plan.
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Profile of medical charges for children by health status group and severity level in a Washington State Health Plan.

机译：华盛顿州卫生计划中按健康状况组和严重性级别划分的儿童医疗收费概况。

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OBJECTIVE: To identify children and evaluate patterns of charges for pediatric medical care, by overall health status, severity of illness, and categories of medical service. Data Sources Enrollment, claims, and charges data from a Washington State health plan. The study population includes all children ages 0 to 18 years during calendar year 1999. STUDY DESIGN: Children were classified into clinically defined health status groups and severity levels using Clinical Risk Groups (CRGs). Health plan charges were analyzed according to core health status group, severity level, and category of service. DATA COLLECTION: The three secondary data sources were obtained electronically from the health plan and cleaned for unique members and data quality before analysis. PRINCIPAL FINDINGS: Children classified as healthy (85.2 percent) had mean and median annual charges of dollar 485 and dollar 191. Children with one or more chronic conditions (9.5 percent) had mean and median charges increasing by status and severity group from dollar 2,303 to dollar 76,143 and from dollar 1,151 to dollar 19,456, and accounted for 45.2 percent of all charges. Distribution of charges varied across health status groups. Healthy children had 70.6 percent of their charges in outpatient and physician services. Children classified in the complex, catastrophic, and malignancy groups had 67 percent of their charges in inpatient encounters. Children with chronic conditions accounted for 31.8 percent of all physician, 41.8 percent of outpatient, 47.7 percent of pharmacy, 60.7 percent of inpatient, and 75.8 percent of all other charges. CONCLUSIONS: Children with chronic conditions account for a disproportionately high percentage of children's health expenditures. They account for different percentages of expenses for different medical services. These percentages vary according to health status and severity. This analysis can be used to identify and track groups of children for various purposes.
机译：目的：根据整体健康状况，疾病严重程度和医疗服​​务类别，识别儿童并评估儿科医疗收费模式。数据源华盛顿州卫生计划的入学，索赔和收费数据。研究人群包括1999日历年中所有0至18岁的儿童。研究设计：使用临床风险组（CRG）将儿童分为临床定义的健康状况组和严重性水平。根据核心健康状况组，严重性级别和服务类别对健康计划收费进行了分析。数据收集：从健康计划中以电子方式获取了三个辅助数据源，并在分析之前对其进行了清理，以确保唯一的成员和数据质量。主要调查结果：健康儿童（85.2％）的平均和中位数年费为485美元和191美元。患有一种或多种慢性病的儿童（9.5％）的平均和中位数年费由状况和严重程度组从2,303美元增加到76,143美元，从1,151美元升至19,456美元，占所有费用的45.2％。费用分配在不同健康状况组之间有所不同。健康儿童的门诊和医师服务费用占总费用的70.6％。分类为复杂，灾难性和恶性组的儿童在住院期间承担了67％的费用。患有慢性疾病的儿童占所有医生的31.8％，门诊的41.8％，药房的47.7％，住院的60.7％以及所有其他费用的75.8％。结论：患有慢性疾病的儿童占儿童健康支出的比例过高。他们在不同医疗服务费用中所占的百分比不同。这些百分比根据健康状况和严重程度而有所不同。此分析可用于出于各种目的识别和跟踪儿童组。

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