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Hospital use patterns for children in the United States, 1983 and 1984
L J Kozak1, C Norton, M McManus
1Division of Health Care Statistics, National Center for Health Statistics, Hyattsville, MD 20782.
Insights
In 1983-1984, US children
Area of Science:
- Pediatric Health Services Research
- Health Economics and Policy
- Public Health Surveillance
Background:
- The United States experienced a significant 12% decline in hospital discharge rates for children under 15 between 1983 and 1984.
- This decrease marked the first statistically significant annual drop in pediatric hospitalizations in the National Hospital Discharge Survey's 20-year history.
- The period coincided with the introduction of prospective hospital payment systems and the expansion of prepaid group health plans and alternative healthcare delivery models.
Purpose of the Study:
- To evaluate the unprecedented decrease in children's hospital use during a period of healthcare system reform.
- To analyze changes in pediatric hospital utilization by demographic factors, payment sources, and diagnostic categories.
- To assess potential correlations between declining hospital use and changes in children's health status or physician service utilization.
Main Methods:
- Utilized data from the National Hospital Discharge Survey, a continuous survey collecting information from a national sample of discharged patient medical records.
- Analyzed pediatric hospital use rates stratified by age (specifically 1-4 years), sex, region, and expected principal source of payment.
- Investigated patterns and changes in hospital use across different diagnostic categories, focusing on diseases of the respiratory system.
Main Results:
- Significant decreases in discharge rates were observed for children aged 1 to 4 years and for all children with private insurance.
- A notable 19% reduction in pediatric discharge rates was found for diseases of the respiratory system.
- While respiratory disease mortality slightly decreased for children under 5, most health status indicators remained unchanged; medically attended acute conditions also declined among this age group.
Conclusions:
- The decline in pediatric hospitalizations, particularly for respiratory conditions, may be linked to evolving healthcare payment and delivery systems.
- The observed decrease in medically attended acute conditions suggests a potential shift in healthcare-seeking behaviors or utilization patterns.
- Continued monitoring of pediatric hospital use, health status, and alternative service utilization is crucial for understanding the impact of healthcare system changes.
Abstract:
The hospital discharge rate of children less than 15 years of age in the United States declined 12% from 1983 to 1984. This was the first time in the 20-year history of the National Hospital Discharge Survey that there was a statistically significant decrease in children's hospital discharge rates in a 1-year period. The change occurred during a period when prospective hospital payment systems were introduced and when prepaid group health plans and alternative systems of providing health care were expanding. The unprecedented decrease in children's hospital use was evaluated using data from the National Hospital Discharge Survey. This is a continuous survey in which data from a national sample of medical records of discharged patients are collected. Children's hospital use rates were reviewed by age, sex, region, and expected principal source of payment. Significant decreases in discharge rates were found for the age group 1 to 4 years and for all children with private insurance. The patterns and changes in hospital use by diagnostic category were also investigated. The major finding was a 19% decrease in children's discharge rate for diseases of the respiratory system. Mortality statistics and data from the National Health Interview Survey were evaluated for indications of changes in children's health status or use of physician services accompanying the decline in hospital use. Although there were fewer deaths due to respiratory diseases for children less than 5 years of age in 1984 than in 1983, most measures of health status were unchanged. The only significant change in physician use was a decrease in the percentage of acute conditions that were medically attended, also among children less than 5 years of age. It is important to continue monitoring children's hospital use patterns, as well as their health status and use of alternative health services, to further assess the impact of changes in the organization and financing of health services.