Health-Care Use and Expenditures for Children in Special Education with Special Health-Care Needs: Is Dual Classification a Marker for High Use?

Abstract

Objectives. Children with special health-care needs are an important group for policy and research planning. Special education engages a group of children with increased utilization of services related to education. While increased service utilization in education or health-care settings is often used to classify children as having special needs, considerable heterogeneity exists within each group. The extent to which being identified in two functionally defined systems—special education and health care—relates to health-care utilization is unknown. We sought to determine health-care and mental health utilization and expenditures for children dually classified as receiving special education and having special health-care needs (SHCN) compared with those who only have SHCN, only are in special education, or don't fall into either category. Methods. A nationally representative sample of children aged 5–17 years from the Medical Expenditure Panel Survey was used to compare mean health-care and mental health utilization and expenditures for the four groups. Results. Dually classified children had significantly higher mean utilization of health-care services than the other three groups ( p,0.05). Mean 12-month total health-care expenditures were highest for dually classified children ($3,891/year) ( p,0.05) and higher for children classified only as having SHCN ($1,426/year) than for children with neither classification ($644/year, p,0.05). Conclusions. Children dually classified as receiving special education and having SHCN represent a subgroup of children with SHCN with high levels of health-care utilization and expenditures. This information can assist policy makers in identifying characteristics that place children at risk for very high expenditures, and in allocating health-care resources.