Healthcare Utilization and Costs Among Commercially Insured Infants With and Without Medically Complex Conditions

Area of Science:

• Healthcare Economics
• Pediatric Health Services Research
• Neonatal Care Outcomes

Background:

• Limited data exists on healthcare utilization and costs for commercially insured infants post-Neonatal Intensive Care Unit (NICU) hospitalization.
• Understanding these patterns is crucial for financial planning and resource allocation.

Purpose of the Study:

• To assess healthcare utilization and associated costs in the first 12 months after neonatal hospitalization.
• To compare infants with and without medically complex conditions.

Main Methods:

• Retrospective cohort study using the IBM MarketScan Commercial database (2015-2019).
• Included infants hospitalized at birth in the NICU with continuous 12-month coverage.
• Analyzed healthcare utilization (readmissions, ED visits, outpatient visits) and out-of-pocket costs.

Main Results:

• Medically complex infants showed higher rates of readmissions, emergency department visits, and specialist utilization.
• Average out-of-pocket costs were significantly higher for medically complex infants ($1893) compared to non-complex infants ($873).
• Nearly half of all infants incurred over $500 in costs during their first year.

Conclusions:

• Medical complexity is a key factor influencing healthcare use and spending in infants post-NICU hospitalization.
• Findings highlight the financial burden on families and the need for targeted support.
• Insights can inform policymakers and providers in addressing the financial challenges of caring for infants with complex conditions.