Charges for Childhood Asthma by Hospital Characteristics

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Abstract
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 ≤18 years of age with the principal diagnosis asthma in 1994 were extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, providing a stratified sample of 735 nonfederal, acute-care hospitals in 17 states. Multiple regression analysis on log transformed data was used to calculate mean total charges and average length of stay (ALOS) after adjusting for illness severity and mortality risk (four All Patient Refined–Diagnosis Related Group classes based on secondary diagnoses and procedures); payer (Medicaid, private, uninsured, other); patient age, sex, income (four categories based on ZIP code of residence); state; bed size (three categories varying by location); hospital ownership; location; teaching status; and admission month.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.