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Obesity, mental illness associated with teens incurring high insurance costs

Adolescents who accounted for the top 1% of total direct medical expenses were twice as likely to be obese, have chronic complex conditions or have mental health conditions, according to recently published data.

“In this analysis of [total direct medical expenses] of a large population of privately insured adolescent patients, we found that the 1% of patients who incurred the highest charges accounted for almost one-fourth of costs, a skewed distribution similar to other pediatric studies of both privately and publicly insured patients,” the researchers wrote. 

The researchers analyzed data from 13,103 privately insured adolescents aged 13 to 21 years to assess direct medical expenses, as well as clinical diagnoses and health care services of high-cost privately insured adolescents in primary care settings.

Among all participants, total direct medical expenses (TDME) were $41.2 million, with a median cost of $1,167 per patient. 

In total, 132 patients were considered high-cost, with a median cost of $52,577 per patient. High-cost patients accounted for 23.6% of TDME.

More than half (59.1%) of high-cost patients had at least one behavioral health diagnosis, making mental health disorders the most common diagnosis among high-cost patients, followed by pharmacy costs (28.4% TDME), according to the researchers. Primary care only accounted for 1% of TDME. 

Obesity, behavioral health diagnoses and having one or more complex chronic conditions were significantly associated with high-cost patients.

“There is an urgent need for health care professionals to understand and proactively identify high-cost patients for clinical interventions. For privately insured adolescents, potential strategies for cost reduction include care coordination for those with [chronic complex conditions] and mental health diagnoses, integrated behavioral health care, and negotiation to reduce pharmacy cost, especially for orphan drugs,” the researchers concluded. – by Casey Hower

Disclosures: The researchers report no relevant financial disclosures.