LAUSR

* Abbreviations: ABSM — : area-based socioeconomic measure BCBSMA — : Blue Cross Blue Shield of Massachusetts In their article in this issue of Pediatrics , Chien et al1 appear to raise an interesting policy dilemma. By using data from Blue Cross Blue Shield of Massachusetts (BCBSMA) during the period from 2008 to 2012, the authors linked annual plan payment claims to geocoded socioeconomic background information on the plan’s pediatric participants aged 0 to 20 years. They found that children living in census tracks with higher socioeconomic characteristics used more services at higher unit prices than children living in census tracts with lower socioeconomic characteristics. If payments to plans are risk-adjusted on the basis of the socioeconomic status of enrollees, then these findings suggest that resources will be directed to plans that enroll children from better-off families relative to plans that enroll poorer children, which is an impact at odds with the expectations of those who advocate for adding socioeconomic status to risk stratification algorithms. The study’s principal finding should not be all that surprising. Health care services are “normal” goods, meaning that as income rises, … Address correspondence to Andrew D. Racine, MD, PhD, Executive Offices, Montefiore Health System, 111 East 210th St, Bronx, NY 10467. E-mail: aracine{at}montefiore.org