The costs of children with sickle cell anemia

Preparing for managed care

Joshua H. Bilenker, Wendy E. Weller, Thomas J. Shaffer, George J Dover, Gerard F Anderson

Research output: Contribution to journalArticle

Abstract

Purpose: To anticipate the clinical challenges and financial risks facing physicians and managed care organizations who care for children with chronic illnesses, such as sickle cell anemia (SCA), under capitated managed care arrangements. Patients and Methods: A cross-sectional study based on claims data from the Washington State Medicaid Program (WSMP) and the Federal Employees Health Benefits Program (FEP). Expenditure patterns were compared for children 18 years of age or younger for whom a claim with a diagnosis of SCA was submitted and paid in the State of Washington during fiscal year 1993 (FY1993) or by the FEP during FY1992 to expenditure patterns for all children. Results: Children with SCA had mean expenditures 8.8 times the mean expenditures for all children in WSMP. There was wide variation in the annual expenditures among children with SCA; the most expensive 10% of children accounted for 56% of total expenditures. Ninety-seven percent of the expenditures were concentrated in four broad categories: 72% for inpatient care, 11% four outpatient care, 11% for physician payments, and 3% for prescription drugs. Examination of expenditure and utilization patterns for children with sickle cell anemia enrolled in the FEP yielded similar results. Conclusions: Unless managed care organizations and capitated pediatricians receive payment rates that reflect the higher expected expenditures of caring for these children, access to and quality of care may suffer. Analyses of practice guidelines and utilization patterns suggest that newborn screening, regular access to specialty facilities, and comprehensive education programs are critical areas that are vulnerable to reductions under capitation.

Original languageEnglish (US)
Pages (from-to)528-533
Number of pages6
JournalJournal of Pediatric Hematology/Oncology
Volume20
Issue number6
DOIs
StatePublished - Nov 1998

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Managed Care Programs
Sickle Cell Anemia
Health Expenditures
Costs and Cost Analysis
Polytetrafluoroethylene
Medicaid
Organizations
Physicians
Prescription Drugs
Quality of Health Care
Insurance Benefits
Occupational Health
Ambulatory Care
Child Care
Practice Guidelines
Inpatients
Chronic Disease
Cross-Sectional Studies
Newborn Infant
Education

Keywords

  • Capitation
  • Chronic illness
  • Costs
  • Managed care
  • Medicaid
  • Risk adjustment
  • Sickle cell anemia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Hematology

Cite this

The costs of children with sickle cell anemia : Preparing for managed care. / Bilenker, Joshua H.; Weller, Wendy E.; Shaffer, Thomas J.; Dover, George J; Anderson, Gerard F.

In: Journal of Pediatric Hematology/Oncology, Vol. 20, No. 6, 11.1998, p. 528-533.

Research output: Contribution to journalArticle

Bilenker, Joshua H. ; Weller, Wendy E. ; Shaffer, Thomas J. ; Dover, George J ; Anderson, Gerard F. / The costs of children with sickle cell anemia : Preparing for managed care. In: Journal of Pediatric Hematology/Oncology. 1998 ; Vol. 20, No. 6. pp. 528-533.
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