Between 1983 and 1998, Medicaid expansion and managed care caused major shifts in the way hospital services are delivered. To date, no one has evaluated the longitudinal impact of these changes on children's quality of care. OBJECTIVES: To describe infrastructure changes for hospitals serving children, changes in quality of care indicators, and the relationship between these. METHODS: Hospital discharge files for 1983-1998 identified over 5.4 million California discharges age 30 days to 19 years. These data were merged with annual files describing hospital structural characteristics. Multivariate models at the individual and hospital level examined relationships over time between changes in the hospital infrastructure and changes in quality of care indicators. RESULTS: The number of all licensed hospitals dropped 15%; the number discharging children declined 25%. In 1983, 100 hospitals discharging children operated under public auspices; in 1998, 60. Among hospitals discharging children, significant reductions occurred in availability of emergency rooms, 24-hour on-call physicians, and pediatric beds. ER and ER Medicaid admissions increased at a rate greater than total ER admissions. With fewer hospitals and fewer beds, average child census increased. A steady 56 to 58% of hospitals discharging children had no pediatric capacity as measured by licensed pediatric beds. Complications and non-routine dispositions increased and were related to hospital substructure changes. Poor children and children of color were particularly affected. CONCLUSIONS: Basic indicators one might use to conclude that quality of hospital care had improved as a result of Medicaid and managed care expansions were incompatible with that expectation. See www.ucsf.edu/fhop/
Learning Objectives: 1. Describe infrastructure changes for hospitals serving children. 2. Describe changes in quality of care indicators. 3. Analyze the impact of managed care on the quality of children's hospital care.
Keywords: Children and Adolescents, Health Care Quality
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.