Mental health, substance use, and other behavioral health care made up 40% of all health expenditures for U.S. children in 2022, according to a new study by researchers at UC San Francisco. That is almost twice what it was in 2011.
The costs to families for this type of care grew more than twice as fast as the costs for other types of medical care. Out-of-pocket spending on behavioral health rose an average of 6.4% each year for families, compared with 2.7% for non-behavioral health care.
"Families are bearing growing costs," said Ashley Foster , MD, lead author of the study, which appears Dec. 15 in JAMA Pediatrics, 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."
The researchers reviewed 11 years of national spending data from 2011 through 2022 for children between the ages of 6 and 17. By 2022, behavioral health accounted for $41.8 billion of overall health spending, and families were paying $2.9 billion - more than a quarter of their out of pocket health spending - for this type of care.
Having a child who needs behavioral health care increases a family's risk of financial hardship.
"Families with at least one child who has behavioral health issues are 60% more likely to face a high financial burden, and 40% more likely to have an extreme financial burden - meaning more than 10% of their family income goes toward that care," Foster said.
While the study wasn't designed to investigate causes for the rise in spending, there are some clues in the data.
"It's likely a combination of a few factors: more children having behavioral health challenges, in part due to the COVID-19 pandemic; a rise in costs per visit over time; and an increase in access to care," Foster said. "Access has improved thanks to less stigma about mental health challenges and because there are more community-based care venues now."
The research also revealed shifts in how and where children receive behavioral health treatment. Spending jumped 25% per year for home health services and 11% per year for in-person outpatient visits. The number of telehealth visits spiked 99% per year between 2020 and 2022. "Telehealth is here to stay," said Foster.
Journal: JAMA Pediatrics
Co-Authors: Please see the paper.
Funding and Disclosures: None to disclose.
About UCSF Benioff Children's Hospitals: UCSF Benioff UCSF Benioff Children's Hospitals are among the nation's leading pediatric specialty hospitals, according to U.S. News & World Report 2025-26 rankings. Their expertise covers virtually all pediatric conditions, including cancer, heart disease, neurological disorders, pulmonology, diabetes and endocrinology, as well as the care of critically ill newborns. The two campuses in San Francisco and Oakland are known for basic and clinical research, and for translating research into interventions for treating and preventing pediatric disease. They are part of UCSF Health, whose adult hospital ranks among the top medical centers nationwide and serves as the teaching hospital for the University of California, San Francisco, a national leader in biomedical research and graduate-level health/sciences education. Visit www.ucsfhealth.org .
