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Health Serv Res. 2019 Apr;54(2):337-345. doi: 10.1111/1475-6773.13096. Epub 2018 Dec 3.

Rural-urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury.

Author information

1
College of Nursing, Health Sciences Campus, Washington State University, Spokane, Washington.
2
Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia.
3
School of Social Work, University of Washington, Harborview Injury Prevention and Research Center (HIPRC), Seattle, Washington.
4
College of Nursing, University of South Carolina, Columbia, South Carolina.
5
Department of Pediatrics, School of Medicine, University of Washington, Harborview Injury Prevention and Research Center (HIPRC), Seattle, Washington.
6
Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle Children's Research Institute, Harborview Injury Prevention and Research Center (HIPRC), Seattle, Washington.
7
Department of Rehabilitation Medicine, School of Medicine, University of Washington, Harborview Injury Prevention and Research Center (HIPRC), Seattle Children's Research Institute, Seattle, Washington.
8
Departments of Anesthesiology & Pain Medicine and Pediatrics, School of Medicine, University of Washington, Harborview Injury Prevention and Research Center (HIPRC), Seattle, Washington.

Abstract

OBJECTIVES:

To compare health care costs and service utilization associated with mild traumatic brain injury (mTBI) in rural and urban commercially insured children.

DATA SOURCE:

MarketScan Commercial Claims and Encounters Data, 2007-2011.

STUDY DESIGN:

We compared health care costs and outpatient encounters for physical/occupational therapy, speech therapy, and psychiatry/psychology encounters 180 days after mTBI among rural versus urban children (<18 years).

PRINCIPAL FINDINGS:

A total of 387 846 children had mTBI, with 13 percent residing in rural areas. Adjusted mean total health care costs in the 180 days after mTBI were $2778 (95% CI: 2660-2897) among rural children, compared to $2499 (95% CI: 2471-2528) among urban children (adjusted cost ratio 1.11, 95% CI 1.06-1.16). Rural-urban differences in utilization for specific services were also found.

CONCLUSIONS:

Total health care costs were higher for rural compared to urban children despite lower utilization of certain services. Differences in health service utilization may exacerbate geographic disparities in adverse outcomes associated with mTBI.

KEYWORDS:

health care costs; health service utilization; pediatrics; rehabilitation; rural health

PMID:
30507042
PMCID:
PMC6407359
[Available on 2020-04-01]
DOI:
10.1111/1475-6773.13096

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