Behavioral health care has surged to represent 40 % of all medical expenditures for U.S. children in 2022, nearly doubling from 22 % in 2011, according to a new study published in JAMA Pediatrics. Researchers found that pediatric behavioral health expenditures totaled $41.8 billion in 2022, with families paying $2.9 billion out-of-pocket. Most concerning, out-of-pocket costs for children's behavioral health increased at more than twice the rate of other medical expenses, leaving many families struggling with significant financial burden.
The study analyzed data on nationally representative spending patterns for U.S. children ages 6-17 from 2011 to 2022. Researchers found that pediatric behavioral health out-of-pocket spending increased 6.4 % annually, compared to 2.7 % annually for non-behavioral health medical spending. By 2022, more than one-quarter of total pediatric out-of-pocket spending for health care was directed toward behavioral health.
"We were surprised by the magnitude of spending for children's behavioral health, and especially the dramatically rising out-of-pocket costs for families," said senior author Kenneth Michelson, MD, MPH, emergency medicine physician at Ann & Robert H. Lurie Children's Hospital of Chicago and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine.
Our findings provide a striking perspective on the youth behavioral health crisis."
Kenneth Michelson, MD, MPH, Emergency Medicine Physician, Ann & Robert H. Lurie Children's Hospital of Chicago
The financial impact on families is substantial. The study found that 1 in 21 U.S. families experiences extreme financial burden due to out-of-pocket health care costs, meaning that more than 10% of family income is allocated towards those costs. Families with at least one child receiving behavioral health services were about 40% more likely to experience extreme financial burden.
"Many families are forced to seek care outside of their insurance network, facing higher out-of-pocket costs for their children's behavioral health care. Our findings underscore the critical need for adequate networks and improved insurance coverage to reduce the financial burden on families," said co-author Jennifer Hoffmann, MD, MS, emergency medicine physician at Lurie Children's and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "We need stronger state-level insurance parity laws, meaning equal insurance coverage for behavioral and non-behavioral health care."
The study also revealed significant shifts in how and where children receive behavioral health care. Expenditures increased dramatically for home health care (25 % per year), outpatient in-person visits (11 % per year), and outpatient telehealth visits (99 % per year from 2020-2022).
"Telehealth rapidly expanded during the pandemic and is likely to remain a lasting component of behavioral health delivery in the U.S.," said Dr. Hoffmann. "However, gaps in funding for telehealth remain. Better reimbursement rates are needed. Regulations also need to be adjusted to enable children to access telehealth across state lines."
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