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Healthcare Utilization and Costs Among Commercially Insured Infants With and Without Medically Complex Conditions
Ashlee J Vance1, James Henderson, Zhe Yin
1Author Affiliations: Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan (Dr Vance); College of Nursing (Dr Vance), Department of Pediatrics, College of Human Medicine (Dr Vance), Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine (Dr Meghea), Michigan State University, East Lansing, Michigan; Institute for Healthcare Policy and Innovation (Dr Henderson and Mr Yin), Department of Internal Medicine (Dr Henderson), University of Michigan, Ann Arbor, Michigan ; and School of Nursing, Yale University, Orange, CT (Dr Costa).
Insights
Infants with medically complex conditions after Neonatal Intensive Care Unit (NICU) hospitalization incur higher healthcare utilization and out-of-pocket costs. Medical complexity, not just prematurity, drives these increased healthcare needs and expenses in the first year of life.
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.
Background:
Little is known about healthcare use and costs for commercially insured infants in the first year of life following a Neonatal Intensive Care Unit (NICU) hospitalization.
Purpose:
To evaluate healthcare utilization and costs in the 12-months after a neonatal hospitalization among commercially insured infants, comparing infants with and without medically complex conditions.
Methods:
This retrospective, cross-sectional, cohort study uses data from the IBM MarketScan Commercial database (2015-2019). The cohort included infants with and without medically complex conditions, hospitalized at birth in the NICU, discharged alive, and had 12-months continuous coverage. The primary outcomes are healthcare utilization (i.e., hospital readmissions, emergency department (ED) visits, and primary care and specialty outpatient visits) and out-of-pocket (OOP) costs.
Results:
The analysis included 23,940 infants, of which 84% resided in urban areas, 48% were born term (>37 weeks) and 43% had a medically complex diagnosis. Medically complex infants exhibited higher rates of readmissions, ED visits, specialist utilization, and specialty services. Average OOP costs for medically complex infants was $1893, compared to $873 for noncomplex infants. Almost half (48%) of the cohort had costs that exceeded $500 in the first year of life.
Implications For Practice And Research:
This study provides insights into the financial implications of post-NICU care for infants. Findings underscore the importance of considering medical complexity over gestational age when understanding healthcare use and spending patterns. Policymakers, healthcare providers, and families can use these insights to address the financial challenges associated with caring for infants with complex medical conditions beyond the NICU.
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