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Impact of Payer Status on Hospitalization Outcomes in Pediatric Diabetic Ketoacidosis

David H Arendt1, Benson S Hsu2,3

  • 1University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

South Dakota Medicine : the Journal of the South Dakota State Medical Association
|January 11, 2022
PubMed

Insights

Children with type 1 diabetes and diabetic ketoacidosis (DKA) on Medicaid experienced longer hospital stays, more procedures, and higher costs compared to privately insured children. These disparities persisted even after accounting for socioeconomic factors.

Area of Science:

  • Pediatric Endocrinology
  • Health Services Research
  • Healthcare Economics

Background:

  • Diabetic ketoacidosis (DKA) is a severe complication of type 1 diabetes (T1D), particularly impacting pediatric populations.
  • DKA in children often represents the initial diagnosis of T1D, incurring significant annual healthcare costs in the U.S.
  • Payer type is a critical factor influencing healthcare access and outcomes in pediatric DKA management.

Purpose of the Study:

  • To investigate the association between payer type (Medicaid vs. private insurance) and healthcare costs and outcomes in pediatric patients with DKA.
  • To test the hypothesis that Medicaid coverage is associated with negative impacts on costs and care for pediatric DKA patients.

Main Methods:

  • Analysis of the 2012 Kids' Inpatient Database (KID) from the Agency for Healthcare Research and Quality (AHRQ).
  • Inclusion criteria focused on pediatric admissions coded for T1D DKA with uniform severity and identifiable Medicaid or private payer status.
  • Severity-adjusted data for 27,241 discharges were analyzed, comparing outcomes between Medicaid and privately insured groups.

Main Results:

  • Medicaid-covered patients (51.6%) showed a longer average length of stay (2.24 days) compared to privately insured patients (2.09 days).
  • Medicaid patients underwent slightly more procedures (0.13 vs. 0.12) and incurred higher total charges ($16,449 vs. $16,107).
  • These trends persisted even when analyzing a subset of patients in the bottom income quartile.

Conclusions:

  • Pediatric DKA patients with Medicaid experienced longer hospitalizations, increased procedures, and elevated total healthcare costs.
  • The observed disparities in care and cost associated with payer type remained significant after controlling for socioeconomic status.
  • Further research is needed to identify the underlying causes of these differences in care delivery based on insurance status.
Abstract

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