Background

Initiatives to reduce healthcare expenditures often focus on imaging, suggesting that imaging is a major driver of cost.

Objective

To evaluate medical expenditures and determine if imaging was a major driver in pediatric as compared to adult populations.

Methods

We reviewed all claims data for members in a value-based contract between a commercial insurer and a healthcare system for calendar years 2021 and 2022. For both pediatric (<18 years of age) and adult populations, we analyzed average per member per year (PMPY) medical expenditures related to imaging as well as other categories of large medical expenses. Average PMPY expenditures were compared between adult and pediatric patients.

Results

Children made up approximately 20% of members and 21% of member months but only 8–9% of expenditures. Imaging expenditures in pediatric members were 0.2% of the total healthcare spend and 2.9% of total pediatric expenditures. Imaging expenditures per member were seven times greater in adults than children. The rank order of imaging expenditures and imaging modalities was also different in pediatric as compared to adult members.

Conclusion

Evaluation of claims data from a commercial value-based insurance product shows that pediatric imaging is not a major driver of overall, nor pediatric only, healthcare expenditures.

中文翻译：

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对基于商业价值的保险产品的索赔数据的评估表明，儿科成像并不是整体或儿科医疗保健支出的主要驱动因素

背景

减少医疗保健支出的举措通常集中在成像上，这表明成像是成本的主要驱动因素。

客观的

评估医疗支出并确定与成人相比，影像学是否是儿科的主要驱动因素。

方法

我们审查了商业保险公司与医疗保健系统之间签订的 2021 和 2022 日历年基于价值的合同中会员的所有索赔数据。对于儿童（<18 岁）和成人群体，我们分析了每位会员每年的平均索赔数据（ PMPY）与影像相关的医疗支出以及其他类别的大额医疗费用。比较成人和儿童患者的平均 PMPY 支出。

结果

儿童费用约占会员的 20% 和会员月份的 21%，但仅占支出的 8-9%。儿科会员的影像支出占医疗保健总支出的 0.2%，占儿科总支出的 2.9%。成人每位成员的影像支出是儿童的七倍。与成人成员相比，儿科的成像支出和成像方式的排名顺序也不同。

结论

对基于商业价值的保险产品的索赔数据的评估表明，儿科成像并不是整体（也不仅仅是儿科）医疗保健支出的主要驱动因素。