Hospitals caring for children with serious, chronic illness are highly dependent on public payers, according to an as-yet published study by the Pediatric Academic Societies.
From research released from the study, the findings show that proposals to dramatically reduce federal expenditures on the Medicaid and Children's Health Insurance Program (CHIP) could destabilize current specialty care referral networks serving all children, including the majority of privately-insured children in need of specialized care.
Although Medicaid and CHIP are directed at providing health services for low-income children, the potential impact of reduced Medicaid and CHIP spending on regionalized systems of hospital care for seriously ill children hasn't been explored in-depth before.
The objectives of the study were to assess the role of Medicaid and CHIP in regional hospitals serving large numbers of seriously ill children; to assess the importance of those regional hospitals to privately-insured, seriously ill children; and to assess the characteristics of the hospitals with the highest patient volume and Medicaid and CHIP dependence.
Researchers conducted a retrospective analysis between the 2012 national Kids' Inpatient Database, or KID, and the 2012 California confidential, unmasked Patient Discharge Database from the Office of Statewide Health Planning and Development. Public payers were defined as Medicaid and CHIP, and major pediatric hospitals as those with more than 500 discharges of children 18 and younger with a serious, chronic illness -- prematurity, congenital heart disease and cancer among them.
Nationally, major pediatric hospitals reported more than half of bed days covered by public payers with the 10 highest-volume hospitals ranging from 36 percent to 100 percent. Similarly in California, 69 percent of bed days were covered by public payers with the six highest-volume hospitals reporting more than 50 percent public payers. One in three privately-insured children were discharged from major hospitals with more than 50 percent public payers.
The characteristics of hospitals in the top quintile of Medicaid bed days had more than 50 percent publicly insured discharges. Of these, 63 percent were urban, most often in the south (36 percent) and least often in the northeast (12 percent), 21 percent were urban teaching hospitals, and 70 percent were children's hospitals.
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