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Psychosocial Morbidity
The Economic Burden in a Pediatric Health Maintenance Organization Sample
Pilar Bernal, MD;
Debra Bendell Estroff, PhD;
Jean Frederic Aboudarham, PhD;
Michael Murphy, EdD;
Anthony Keller;
Michael S. Jellinek, MD
Arch Pediatr Adolesc Med. 2000;154:261-266.
Objectives To evaluate psychosocial morbidity in pediatric primary care and to determine displaced health care utilization.
Design and Setting A cross-sectional sample of parent-child dyads was screened using the Pediatric Symptom Checklist (PSC) at 6 pediatric sites of a health maintenance organization (HMO). Cost and utilization data were retrieved from regional databases for this sample.
Participants Parent-child dyads from an HMO in northern California (N = 1840). The children ranged in age from 2 to 18 years.
Results In all, 13.0% of children exhibited psychosocial dysfunction. The rate of children's chronic illness was 18.4%. Multiple regression analyses measured utilization and cost of health and psychiatric care for the selected population for the previous year; the average log cost of health care per child was $393. The average health care cost for children with anxious, depressed symptoms was $805. Chronically ill children were the highest utilizers of health care, with an average log cost of $1138. When psychosocial dysfunction was present, regression models showed that health care spending was highest for young children.
Conclusions Health care utilization was higher for children with psychosocial morbidity, was higher among younger children, and decreased with age as psychiatric costs progressively increased.
From the Department of Psychiatry, Kaiser Permanente Medical Group, San Jose, Calif (Drs Bernal, Bendell Estroff, and Aboudarham and Mr Keller); and the Child Psychiatry Service, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, Mass (Drs Murphy and Jellinek).
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