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Charges for childhood asthma by hospital characteristics
J R Meurer1, E M Kuhn, V George
1Center for the Advancement of Urban Children, Department of Pediatrics.Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Insights
Hospital characteristics like ownership and location significantly impact pediatric asthma care costs, though not length of stay. For-profit and urban teaching hospitals incur higher charges for treating childhood asthma.
Area of Science:
- Pediatric Healthcare Research
- Health Services Research
- Hospital Administration
Background:
- Hospital ownership, location, and teaching status influence institutional operations and patient care.
- Asthma is a leading cause of pediatric hospital admissions, necessitating an understanding of cost variations.
Purpose of the Study:
- To examine how hospital ownership, location, and teaching status correlate with healthcare charges and average length of stay (ALOS) for pediatric asthma patients.
- To identify factors contributing to cost disparities in treating childhood asthma.
Main Methods:
- Analysis of 28,545 patient records for children (<=18 years) with asthma principal diagnosis from the 1994 Nationwide Inpatient Sample.
- Multiple regression analysis adjusted for illness severity, patient demographics, payer status, and hospital characteristics to determine mean total charges and ALOS.
Main Results:
- Average length of stay (ALOS) for pediatric asthma patients was consistent across different hospital types (2.5 days).
- Mean total charges for childhood asthma were significantly higher in for-profit hospitals ($4203) compared to nonprofit ($3640) or public hospitals ($3620).
- Urban teaching hospitals had higher average charges ($4230) than urban nonteaching ($3424) and rural hospitals ($2910).
Conclusions:
- Despite uniform ALOS, significant variations in mean charges for pediatric asthma exist based on hospital ownership, location, and teaching status.
- Further research is needed to understand the drivers of higher costs in for-profit hospitals and to assess care quality variations.
- Policy interventions may be required to address financial disparities in hospitals serving a high proportion of economically disadvantaged children.
Background:
The ownership, location, and teaching status of hospitals affect their missions, policies, finances, and operations.
Objective:
This study assesses the relationship of hospital ownership, location, and teaching status with charges and length of stay for children with asthma, the most common reason for pediatric admission after birth.
Methods:
All 28 545 complete records of patients
Results:
Asthma severity did not differ significantly by hospital location or teaching status. Nonprofit hospitals treated a slightly higher proportion of children with major or extreme severity asthma than either public or for-profit hospitals. Urban teaching hospitals treated more children with asthma who lived in low-income neighborhoods, were uninsured, or received Medicaid coverage than urban nonteaching hospitals. For-profit hospitals admitted fewer children with asthma from low-income areas than did public hospitals. The ALOS was 2.5 days and did not differ significantly by hospital ownership, location, or teaching status. However, the mean total charges, after adjusting for all other significant covariates, was higher at for-profit ($4203) than at nonprofit ($3640) or public hospitals ($3620). Average charges also were higher at urban teaching ($4230) and lower at rural institutions ($2910) compared with urban nonteaching hospitals ($3424).
Conclusions:
Despite similar ALOS, mean charges for childhood asthma varied significantly by hospital ownership, location, and teaching status. Implications. Additional clinical and outpatient data are needed to study variations in quality of care by hospital characteristics. With the proliferation of investor-owned hospitals, both the reasons for and the impact of higher average charges at for-profit institutions require additional investigation. With the expanding needs of the medically underserved, socially just policies are required for financing hospitals that care for a disproportionate share of economically disadvantaged children.