Mental health, substance use, and other behavioral health care accounted for a significant 40% of all health expenditures for U.S. children in 2022, according to a new study by researchers at UC San Francisco. This figure is nearly double what it was in 2011, highlighting a growing financial strain on families.
The study, published in JAMA Pediatrics, reveals that the costs for this type of care have increased more than twice as fast as those for other types of medical care. Families have seen out-of-pocket spending on behavioral health rise by an average of 6.4% each year, compared to just 2.7% for non-behavioral health care.
“Families are bearing growing costs,” said Ashley Foster, MD, lead author of the study and a pediatric emergency care physician at UCSF Benioff Children’s Hospitals. “As a country, we need to make sure behavioral health care is accessible and affordable for every family, regardless of insurance status.”
Financial Burden on Families
The research team reviewed 11 years of national spending data from 2011 through 2022 for children aged 6 to 17. By 2022, behavioral health accounted for $41.8 billion of overall health spending, with families paying $2.9 billion—more than a quarter of their out-of-pocket health spending—for this type of care.
Having a child who requires behavioral health care significantly increases a family’s risk of financial hardship. According to Foster, families with at least one child facing behavioral health issues are 60% more likely to encounter a high financial burden and 40% more likely to face an extreme financial burden, defined as spending more than 10% of their family income on care.
Underlying Causes and Trends
While the study did not specifically investigate the reasons behind the rise in spending, the data suggests several contributing factors. Foster noted that more children are experiencing behavioral health challenges, partly due to the COVID-19 pandemic. Additionally, there has been an increase in costs per visit over time, alongside improved access to care.
“It’s likely a combination of a few factors: more children having behavioral health challenges, a rise in costs per visit, and an increase in access to care,” Foster explained. “Access has improved thanks to less stigma about mental health challenges and because there are more community-based care venues now.”
Shifts in Treatment Modalities
The research also highlighted changes in how and where children receive behavioral health treatment. Spending on home health services surged by 25% per year, and in-person outpatient visits increased by 11% annually. Notably, the number of telehealth visits skyrocketed by 99% per year between 2020 and 2022.
“Telehealth is here to stay,” Foster remarked, reflecting on the rapid adoption of virtual care during the pandemic.
Looking Forward
The findings underscore the urgent need for policy interventions to make behavioral health care more affordable and accessible. As families continue to shoulder a growing financial burden, experts call for systemic changes to support those in need.
UCSF Benioff Children’s Hospitals, where the study’s lead author practices, are recognized among the nation’s leading pediatric specialty hospitals. Their comprehensive expertise spans a wide range of pediatric conditions, including cancer, heart disease, and neurological disorders. The hospitals are part of UCSF Health, which is renowned for its contributions to biomedical research and education.
As the nation grapples with the rising costs of behavioral health care for children, stakeholders are urged to prioritize solutions that ensure equitable access to essential services. The study’s insights serve as a critical reminder of the challenges families face and the need for collective action to address these pressing issues.
