Health care financing policy for hospitalized pediatric patients

Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States

BACKGROUND

There has been a gradual decrease in the proportion of children covered by private health insurance in Colorado and the United States with a commensurate increase in those with public insurance or having no insurance which may impact access to care and outcomes.

OBJECTIVE

The purpose of this work was to determine whether children with public or no health insurance have differences in hospital admission rates, morbidity, mortality, and/or charges that might be improved if standards of primary care comparable to those of children with private insurance could be achieved.

METHODS

We conducted a retrospective comparison of hospitalization-related outcomes for children < 18 years of age in Colorado from 1995-2003 and in the United States in 2000. Population-based rates for hospital admission were determined stratified by age, race/ethnicity, disease grouping, and health insurance status.

RESULTS

Compared with those with private insurance, children in Colorado and the United States with public or no insurance have significantly higher rates of total hospital admission, as well as admission for chronic illness, asthma, diabetes, vaccine-preventable disease, psychiatric disease, and ruptured appendix. These children have higher mortality rates, higher severity of illness, are more likely to be admitted through the emergency department and have significantly higher hospital charges per insured child. Higher hospitalization rates occur in children who are nonwhite and/or Hispanic and those who are younger. If children with public or no health insurance in the United States in 2000 had the same hospitalization outcomes as children with private insurance, $5.3 billion in hospital charges could have been saved.

CONCLUSIONS

There is an opportunity to achieve improved health outcomes and decreased hospitalization costs for children with public or no health insurance if private insurance standards of health care could be achieved for all US children.

An objective method to evaluate rationing of pediatric intensive care beds

Rationing of pediatric intensive care beds occurs when the severity of illness of patients admitted to and discharged from the PICU is inversely proportional to the number of available PICU beds. Bed rationing may also increase the proportion of patients using unique PICU therapies, thereby increasing efficiency. Consecutive PICU admissions (n = 283) were evaluated for three months for descriptive data, daily severity of illness, and daily care modalities. PICU and hospital censuses were also recorded. The mean PICU occupancy was 75% (range 37.5%-100%), the hospital occupancy was 79% (range 60%-96%) and the daily PICU efficiency was 78% (range 50%-100%). The PICU census was greater than 90% on 13% of the study days. Neither PICU nor hospital census was associated with the severity of illness of patients admitted to or discharged from the PICU. Severity of illness for patients admitted when only one bed was available or discharged when there were no available beds was not higher than at other times. Therefore, we did not find evidence of rationing of pediatric intensive care by using quantitative methods. As health care funding becomes more limited, quantitative analyses such as this study differentiating the need for more PICU beds from the need for better PICU bed utilization will be beneficial.