As Kids Grow, Oh, The Pills You'll Take — And What They Cost

When you become a parent, the word "development" stops referring to real estate and starts referring to the expectable changes that come as children grow. It's "developmentally" typical for a child to walk at around 1, be talking some by 2 and be increasingly independent in the teen years.

Now, an informative new report just out from the independent Health Care Cost Institute, which mines millions of health insurance records, offers telling new data on what I would dub "pharamcodevelopment." That is, as American children grow, what medications do they typically take, and at what cost?

One striking trend: Until teen girls start taking birth control pills, boys are significantly likelier to be prescribed drugs. (Yes, a lot of Attention Deficit Disorder meds, but not only.) Then, in the teen years, the genders tend to even out. The average total annual cost of children's prescriptions ranges from about $169 per baby to about $500 per teen. I spoke with Carolina Herrera, director of research at the Health Care Cost Institute, for more insight. Our conversation, edited:

Is this report a "first" in any way?

These are the first numbers on children’s health care expenditures and utilization, and prices that were paid for their services, for 2012. The numbers are on 10.5 million children covered by employer-sponsored health insurance, weighted up to national averages covering every state in the union. So we have the first 2012 numbers on kids.

Between 2009 and 2012, what's the most dramatic change or trend?

The most dramatic trend is probably that children's health care spending grew at about 5.5 percent per year, and through the whole period, it grew faster than expenditures for most adult populations. Children’s health care spending per capita is a lower number than adults', but we saw growth in quite a few areas. Prescription spending is definitely one of them. Spending on infants and teens is another. Both those groups had different motivating factors: For infants it was definitely hospital days; for teens, they continued using all the services they had used before and added more. In particular, we saw the prescription expenditures go up, and we saw the inpatient use for teenaged girls go up.

Inpatient mental health care for both teenaged boys and girls is definitely up. How much of that is coming from kids getting the care they need or families becoming more aware of possibilities of getting mental health care through the inpatient system? How much of that is occurring because maybe outpatient options weren’t available or appropriate? It’s really hard to tell at this macro level. That's one of the areas we'll be encouraging other researchers to look into more, and probably looking into more ourselves in our next big report.

Say you've just had a child. What does the data suggest you can expect for that child in terms of prescriptions over the next 18 years?

What's interesting is what happens as the child ages. We start out life using gastrointestinal drugs and anti-infective drugs; those are the two most common drug classes we're using. As the child gets a little older, to ages 4-8, there's a shift. We see gastrointestinal drugs are no longer one of the top categories. We have anti-infective agents, though a smaller amount per child, and we see for the first time that the second-highest category of drug class use is Central Nervous System agents. CNS agents are typically associated with mental health care.

So that’s mainly ADD, Attention Deficit Disorder drugs?

For the boys, it’s definitely associated with ADD, that is one of the most common subclasses of drugs prescribed to children. For girls, as they age, they have a slightly different mix of CNS drug classes. There are more details in Table A-16 of the report:

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As we age, this trend continues. As you see, boys 8-13 use quite a few CNS drugs, most for ADD. Girls, too, are using CNS drugs as their top class of drugs, and using the same CNS subclasses. But this changes as we reach the teenaged years. Boys continue to use ADD drugs but girls start to use drugs associated with anxiety and depression, and at the same time, they start to go on hormones, and that becomes the largest drug class for them if we look at filled days.

So the boys and girls evened out.

They did. The number of filled days for teenaged boys and teenaged girls for CNS drugs is relatively closer in the teenaged years than it was for previous years.

The mission of the Health Care Cost Institute is to cast light on the drivers of America's high health care costs. So what are the lessons here, whether for controlling health care costs or anything else?

First, we wanted to draw attention to the fact that children are not just small adults, and their health care usage changes as they age. We also wanted to draw attention to how health care spending is different in boys than in girls. And health care spending on boys is higher between birth and age 13; then in the teenaged years, health care spending becomes higher on girls: Girls’ medical spending becomes higher than medical spending on boys, but boys’ prescription spending is higher than spending on teen girls. So there are some important trends to pay attention to here that could make a difference as children age.

Second, we are not a cost control center. Our goal is to put research out there into the hands of policy makers and the public because we're trying to inform the debate about health care in this country. All of our reported data is indicating benchmarks on what happened between 2009 and 2012, and all this could inform analysis on the state of health care spending before the Affordable Care Act and after.

Readers, what most strikes you? What do you most still want to know?

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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