Do Declining Private Insurance Coverage Rates Influence Pediatric Hospital Charging Practices?
ABSTRACT To analyze trends in primary payer composition for pediatric hospitalizations and insurance coverage rates from 2000 to 2006 and possible effects on hospital charging practices.
We documented national trends in hospital charge-to-cost ratios and primary payer mixes for pediatric discharges from 2000 to 2006 using the Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID). We then performed regression analyses at the hospital level to analyze associations between pediatric insurance coverage rates and hospital charge-to-cost ratios.
We found pediatric inpatient charge-to-cost ratios increased dramatically during study period. Charge-to-cost ratios were higher for hospitals located in states with either higher uninsurance rates or a public-private coverage mix that was skewed towards public coverage.
This study provides evidence of both important changes in pediatric health insurance distribution in the United States and hospital charging practices.
Full-textDOI: · Available from: Patricia B Reagan, May 13, 2014
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ABSTRACT: Increasing attention is being paid to medically complex children and young adults, such as those with complex chronic conditions, because they are high consumers of inpatient hospital days and resources. However, little is known about where these children and young adults with complex chronic conditions seek emergency care and if the type of emergency department (ED) influences the likelihood of admission. The authors sought to generate nationwide estimates for ED use by children and young adults with complex chronic conditions and to evaluate if being of the age for transition to adult care significantly affects the site of care and likelihood of hospital admission.Academic Emergency Medicine 07/2014; 21(7). DOI:10.1111/acem.12412 · 2.20 Impact Factor
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ABSTRACT: Study Design. Observational cross-sectional population study using national sample of pediatric hospital discharges from 2000 through 2009.Objective. To determine whether there is an association between insurance status and in-hospital surgical outcome for pediatric patients with idiopathic scoliosis.Summary of Background Data. Association between health insurance status and in-hospital surgical outcome following spinal fusion for pediatric idiopathic scoliosis is unknown.Methods. An analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database 2000, 2003, 2006, and 2009 was performed. Patients aged 0 to <18 years with idiopathic scoliosis and no underlying neurologic disorders who underwent fusion were included. National trends, patient, hospital and surgical characteristics, postoperative in-hospital complications, and associated factors were studied. Univariate analysis and multivariable logistic regressions were used.Results. There were an estimated 19,439 surgeries (Medicaid 4,766 vs. Private 14,673) for pediatric idiopathic scoliosis from 2000 to 2009 in the U.S. Spinal fusions for pediatric idiopathic scoliosis steadily increased from 2000 to 2009 by 18.0%. Patients with private insurance were more likely to have surgery than Medicaid patients (7.7 vs. 5.9 per 100,000 capita, p = 0.003). Patients with private insurance were slightly older than Medicaid patients at the time of surgery (mean age 13.9 vs. 13.4 years, p<0.001). Medicaid patients had higher prevalence of asthma (10.8% vs. 7.4%, p<0.001), hypertension (1.4% vs. 0.4%, p<0.001), hyperlipidemia (0.3% vs. 0.1%, p = 0.01), diabetes (0.8% vs. 0.3%, p<0.001), and obesity (2.6% vs. 1.5%, p<0.001). Medicaid patients underwent more fusions involving ≥9 vertebrae than private patients (43.0% vs. 33.9%, p<0.001). Postoperative in-hospital complications were similar, including neurologic (Medicaid 1.8% vs. Private 1.7%, p = 0.64) and infectious (Medicaid 0.3% vs. Private 0.2%, p = 0.44). Length of stay was longer (6.1 vs. 5.6 days, p<0.001) and hospital costs higher ($45,443 vs. $41,635, p<0.001) for Medicaid patients. Surgery performed in the South and Midwest regions, older age, and female gender were associated with lower rates of in-hospital neurologic complications, while the presence of cardiac disease, obesity, and re-fusion were associated with higher rates of in-hospital neurologic complications.Conclusion. Medicaid patients were younger, underwent longer fusions, and had more medical comorbidities than patients with private insurance. However, insurance status was not associated with increased rate of postoperative in-hospital complications.Spine 12/2014; 40(4). DOI:10.1097/BRS.0000000000000729 · 2.45 Impact Factor