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Direct Cost of Critical Illness Associated Healthcare Expenditures among Children Admitted in Pediatric Intensive
Vivek V Shukla1, Somashekhar M Nimbalkar2, Jaishree D Ganjiwale3
1Division of Neonatology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
Insights
High direct costs for pediatric intensive care in rural India strain families, making critical care unaffordable for many. This impacts care quality and childhood mortality rates.
Area of Science:
- Pediatric critical care
- Health economics
- Public health in developing nations
Background:
- Intensive care units (ICUs) in developing countries face unique challenges.
- Poverty in rural India limits access to essential healthcare services.
- Understanding the financial burden of pediatric critical care is crucial for policy development.
Purpose of the Study:
- To determine the direct costs of pediatric intensive care.
- To analyze the financial implications for families in rural India.
- To inform strategies for improving access to critical care.
Main Methods:
- Prospective observational cost-analysis study.
- Data collected via questionnaires and billing records over 27 months.
- Included admissions to the Pediatric Intensive Care Unit (PICU).
Main Results:
- Average hospital expenditure was US$185.67 per child (6.16-day stay).
- Ventilated children incurred 61% higher daily costs.
- Mechanical ventilation, organ dysfunction, and insurance status significantly impacted expenses.
Conclusions:
- Direct costs of pediatric intensive care are substantial for rural Indian families.
- Lack of insurance coverage makes critical care unaffordable, leading to suboptimal care and mortality.
- Urgent need for government and global health initiatives to address affordability and access issues.
Objective:
To assess the direct costs involved in treatment of children receiving intensive care in a university-affiliated teaching hospital and its associated implications on the children's families, in rural India.
Methods:
It was a prospective observational study for cost-analysis using questionnaire based interviews and billing records data collection for admissions to the PICU over 27 consecutive months (January 2010 through March 2012).
Results:
A total of 784 children were admitted to the unit during the assessment period. Full details of 633 children were included for analysis. The average length of stay was 6.16 d, average hospital expenditure was US$185.67, average hospital expenses per day was US$44.00, average pharmacy expenditure was US$109.67 and average pharmacy expenditure per day was US$20.62 per patient. Children who were ventilated had approximately 61 % more expense per day as compared to non-ventilated ones. Boys and those with health insurance reported higher length of stay. Linear hierarchical regression with backward LR model showed that mechanical ventilation, multiple organ dysfunction, length of stay and insurance cover were the variables significantly affecting the final expenses.
Conclusions:
There is a high direct expenditure incurred by families of children receiving intensive care when seen in perspective of high rates of extreme poverty in rural India. These high expenditures make critical care unaffordable to majority of the population lacking insurance cover in resource limited regions with limited universal health coverage, which ultimately leads to suboptimal care and high childhood mortality. It is highly imperative for the governments and global health organizations to be sensitive towards this issue and to plan strategies for the same across different nations.
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