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Identifying Characteristics of Children With High Hospital Costs

BOSTON – The top 10% of the children with the highest annual inpatient cost (CHIC) made up more than half of total inpatient costs in 2010 for 39 U.S. pediatric hospitals, according to a new study.

Yet, most of those children had no hospital costs over the next two years, according to the report in the journal Pediatrics.

In an effort to find out how hospitals can contain costs while providing care for children with high healthcare expenses, a study team led by Boston Children’s Hospital researchers undertook a retrospective study of 265,869 children age 2 to 15 years with one or more admission in 2010 to 39 children’s hospitals in the Pediatric Health Information System.

For the study, CHIC were defined as the top 10% of total inpatient costs in 2010, representing 26,574 pediatric patients.

Results indicate that the top 10% CHIC constituted 56.9% of total inpatient costs in 2010, for a total of $2.4 billion. In 2011 and 2012, however, 58% of those patients had no inpatient costs, although 27%, numbering slightly more than 7,000, racked up persistently high hospital charges.

Most associated with persistently high inpatient costs were chronic respiratory conditions, absence of surgery, and technological assistance. Further statistical modeling showed that the greatest likelihood of persistence, 65.3%, was found in CHIC with three or more hospitalizations in 2010 and a chronic respiratory condition.

“Most children with high children’s hospital inpatient costs in one year do not experience hospitalization in subsequent years,” study authors pointed out. “Interactions of hospital use and clinical characteristics may be helpful to determine which children will continue to experience high inpatient costs over time.”

According to a 2011 statistical brief from the federal Healthcare Cost and Utilization Project, children generally spend less time in the hospital -- an average 3.8 days -- and have about half the average costs than adults. The percentage of those stays being billed to Medicaid is increasing, going from 40% in 2000 to 49% in 2009.