Costs of hospitalization for common pediatric conditions: Relationship to race/ethnicity and family income

BACKGROUND: Many prior studies suggest that significant racial/ethnicity and income disparities exist in both clinical and economic outcomes. Especially, ethnic and racial minority children and underserved populations of children are likely to experience multiple disparities in access to health care services. Concerns about service costs and insurance coverage are more commonly cited access barriers among groups that face multiple social and economic disadvantages.

PURPOSE: The purpose of this study is to investigate whether race/ethnicity and income affects the differences in the costs of common pediatric conditions in the United States. Prior studies examining disparities in the costs of inpatient care for children have often been limited by a focus on charges not the costs of care, or by omitting potentially important information about hospital and market characteristics (e.g., system affiliation, managed care penetration, competition). Therefore, this study addresses the limitations in the literature by employing more relevant data.

METHODS: A retrospective cohort study of children hospitalized with common pediatric conditions is conducted. Using the International Classification of Disease, Ninth Revision (ICD-9), common conditions, such as asthma, bacterial pneumonia, convulsions, dehydration, failure to thrive, gastroenteritis, or urinary tract infections, are identified. Primary data for this study are the Healthcare Cost and Utilization Project (HCUP)'s 2003 Kids' Inpatient Database (KID) which provides key study variables including total charges per admission, race/ethnicity, primary payer, and household income. Potential confounding variables that might influence hospital costs are obtained from the American Hospital Association (AHA)'s Annual Survey, the Area Resource File (ARF) and the Healthcare Cost Report Information System (HCRIS) datasets. In addition, the Cost-to-Charge (CTC) Files is used to convert total charge information to actual cost to see how much hospital services for the sample children actually cost. Statistical analysis focuses on comparing the median total costs and charges by race/ethnicity and by family income. A multivariate regression analysis is also employed to investigate whether the differences in median costs by race/ethnicity and income variables are significant after including the control variables in the model.

RESULTS: The findings of this study shows whether costs are higher for children of minority race/ethnicity, including Black, Hispanic and Asian children, compared to White children. Further, the results demonstrate whether children in low-income families and children with Medicaid cost more compared to those with high-income families and private insurance. Based on the regression analysis, other patient and hospital characteristics that have significant associations with costs are identified.