Practice Style Variation in Medicaid and Non-Medicaid Children With Complex Chronic Conditions Undergoing Surgery

Area of Science:

• Pediatric Surgery
• Health Services Research
• Healthcare Disparities

Background:

• Surgery for children with complex chronic conditions (CCCs) represents a significant portion of resource utilization in children's hospitals.
• Differential payment structures exist between Medicaid and non-Medicaid services.

Purpose of the Study:

• To investigate potential differences in the style of surgical care for similar children with CCCs, comparing those with Medicaid to those without.
• To assess resource utilization and outcomes for pediatric surgical patients with CCCs based on insurance status.

Main Methods:

• A matched cohort design was employed, analyzing 23,582 pairs of children with CCCs undergoing surgery.
• Patients were matched within the same hospital from 2009 to 2013 based on age, sex, principal procedure, and CCCs.
• Data from 41 children's hospitals were included in the analysis.

Main Results:

• Median costs were 5.0% higher for Medicaid patients ($21,547) compared to non-Medicaid patients ($20,527).
• Mean length of stay (LOS) was 0.50 days longer, and ICU utilization was 2.8% higher for Medicaid patients.
• In-hospital mortality was slightly higher in Medicaid patients (0.38% vs. 0.22%, P = 0.002).

Conclusions:

• Treatment styles showed minimal disparities for in-hospital surgical care in children with CCCs.
• While overall care styles were similar, the slightly elevated in-hospital mortality for Medicaid patients requires further investigation.