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Pediatric Capabilities in US Hospitals: 2003-2022.
Kenneth A Michelson1, Emily M Bucholz2, Sriram Ramgopal1
1Division of Emergency Medicine, Ann & Robert Lurie Children's Hospital, Chicago, Illinois.
Pediatrics
|December 9, 2025
Summary
Over two decades, the number of high-capability pediatric hospitals significantly decreased, while low-capability hospitals more than doubled. This trend impacts child access to essential healthcare services.
Area of Science:
- Pediatric Healthcare
- Hospital Systems Analysis
- Healthcare Access Research
Background:
- The availability of specialized pediatric care is crucial for child health outcomes.
- Understanding trends in pediatric hospital capabilities is essential for healthcare planning.
Purpose of the Study:
- To evaluate changes in the availability of pediatric-capable hospitals in the US over a 20-year period (2003-2022).
- To assess shifts in the distribution of hospitals across different pediatric capability levels.
Main Methods:
- Utilized the Healthcare Cost and Utilization Project Kids' Inpatient Database (2003-2022).
- Categorized hospitals into four capability levels (1-4) based on 24 provided services.
- Employed Poisson models to analyze trends in hospital capability levels and specific service provision, adjusting for hospital characteristics.
Main Results:
- A significant decrease in high-capability hospitals was observed: Level 1 down 38%, Level 2 down 54%, Level 3 down 48%.
- Level 4 (minimal service) hospitals increased by 137%.
- Seventy-one percent of specific pediatric services saw fewer capable hospitals in 2022 compared to 2003, with notable declines in appendectomy, pneumonia, and asthma hospitalizations.
Conclusions:
- The US experienced a substantial decline in hospitals with higher pediatric capabilities over two decades.
- The rise in low-capability hospitals suggests a potential barrier to accessing comprehensive pediatric care for various conditions.
- These shifts necessitate a re-evaluation of healthcare resource allocation to ensure adequate pediatric service availability.
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