G163 An analysis of healthcare costs in high-need children and young people

Aims In the context of budget pressures, the need to keep children and young people well and reduce the burden of costly interventions is growing. Little is known about how health spending is distributed amongst the population or how we can identify children at risk of requiring higher spending. Our study aims firstly to identify total health spending costs and relative differences across services for the top 5% of high cost users and secondly to characterise the features of this group. Methods 78,215 participants aged 0–24 were randomly sampled from the Clinical Practice Research Datalink, linked to Hospital Episodes Statistics for the year 2015/16. Total costs were estimated for primary care visits, A&E and outpatient attendances, inpatient admissions, and prescriptions. The high cost group was defined as the top 5% of individuals based on total costs and the proportion also in the same group in 2014/15 was calculated. Results 54% (£17,321,850) of the total yearly health service spending was utilised by the most expensive 5% of participants. The proportion of spending on this group was highest for inpatient costs (88%) and lower for costs relating to Emergency Departments (31%), Outpatients (44%), Primary Care (15%) and medication (38%). Those in the most deprived decile by Index of Multiple Deprivation were more likely to be in the high cost group than those in the least deprived (6% vs 4%). 29% of those in the high cost group in 2015/16 were in the same group the preceding year. Conclusion Just over half of health service costs for children and young people were spent on only 5% of users. While unsurprisingly, much of this was explained by inpatient admissions, spending was higher across all services including prescription costs. There was significant movement into this group, with fewer than one third also in the high cost group the previous year. Proactive strategies are needed to keep children well and reduce the need for costly inpatient care, although further research is needed to understand whether this can be accurately predicted or indeed effectively reduced.