Correlates of therapy use and expenditures in children in the United States

Introduction: This paper describes correlates of use and expenditures for therapies (physical, occupational, speech or home health services) among children in the US. Methods: It examined data from the Medical Expenditure Panel Survey, a nationally-representative US sample. The characteristics of users and described patterns of expenditures were examined. Results: Use is quite low, only 3.8% of children use services or 4.3% once the use that occurs in the special education system is included. Children more likely to use therapy include those with presumably greater need: children with chronic conditions, functional limitations and/or a history of hospitalizations or injuries. There is a significant interaction of minority status and having a functional limitation. Expenditures are low when examined across the child population. Among a small proportion of high users, therapy expenditures account for a large proportion of overall health expenditures. Conclusions: The educational system adds only slightly to the overall rate of use. In general use appears to be related to the need for such services. Some children, likely including racial/ethnic minority children, may under-use services. Lack of insurance is not related to less use, perhaps because there are other ways to get some services (family care or services provided through the public health system) or because not all insurers cover therapy services. Therapy expenditures account for a high proportion of overall expenditures among the high users of therapy whereas, for the entire child population, therapy expenditures account for a very small part of overall health expenditures.