Unplanned Regionalization and Interstate Dependence in Pediatric Hospital Care

Area of Science:

• Healthcare Systems
• Pediatric Medicine
• Health Services Research

Background:

• Pediatric hospital consolidation is increasing in the US.
• States are increasingly dependent on neighboring states for pediatric inpatient services.
• The extent of this interstate dependence is not well-characterized.

Purpose of the Study:

• To describe cross-state pediatric hospital utilization patterns.
• To quantify the degree of interstate dependence for pediatric care in the New England region.

Main Methods:

• Retrospective cross-sectional study of pediatric inpatient admissions (age <15 years) in New England and New York in 2019.
• Exclusion of mental health, routine newborn care, and pregnancy-related admissions.
• Analysis of out-of-state admissions, bed-days, diagnoses, and insurance types.

Main Results:

• Massachusetts provided 71.1% of pediatric admissions and 86.8% of bed-days in the region.
• Interstate care reliance varied significantly, from 2.0% in Massachusetts to 65.8% in New Hampshire.
• Privately insured children were more likely than Medicaid enrollees to receive out-of-state care.

Conclusions:

• New England's pediatric care functions as a de facto regionalized system with significant patient movement and reliance on Massachusetts.
• This unplanned interdependence creates system vulnerabilities.
• Regional planning and formal coordination are essential for sustainable access to pediatric care.