Almost two-thirds of bankruptcy filings have a medical cause and 14.6% of those interviewed for bankruptcy in 2007 had anill child1with a complex medical condition. An estimated 2.8 to 3.3 million individuals with vast medical bills file for bankruptcy each year2. If the percentage of filers with children has remained constant, it means between 408,800 and 481,800 people seeking bankruptcy protection each year have children with complex illnesses severe enough to prompt the filings.
Work published this early relased recently in Pediatrics from (doi: 10.1542/peds.2015-0260) will help provide needed information for children’s medical care and costs in the last year of life. A group of researchers from Boston and Philadelphia used data from the forty-one free-standing children’s hospitals to describe illness and costs for such children. The hospitals submitted data to the Pediatric Health Information System database, an administrative database that contains inpatient utilization and cost data. Children are assigned a unique identifier to track them across multiple admissions. The researchers used the data to characterize the admissions and costs incurred among a cohort of 1,252 children who were admitted and died in calendar year 2012. Infants less than a year of age were excluded to ensure a complete one-year review.
Those children had complex medical conditions in nine organ systems: cardiovascular, congenital/genetic, gastrointestinal, hematologic/immunologic, malignancy, metabolic, neuromuscular, renal and respiratory. The authors converted charges to costs, using an existing ratio for each hospital and they adjusted for inflation by using the Consumer Price Index.
The authors found that the children in their last year of life had medians of two admissions, twenty-seven hospital days and $142,562 in hospital costs. Total hospital costs were $392 million, of which 58% occurred in the final admission for these children to the hospital($228 million).
In a multivariate analysis, children diagnosed with hematological/immunologic conditions have the greatest impact on hospital resource use. Compared to children with other complex conditions, children with hematologic/immunologic conditions spend 45 more days in the hospital and accumulated $326,844 more in hospital costs. The vast majority of children (987, 79%) spent time in the intensive care unit and most were mechanically ventilated (946, 76 %) during their last admissions.
These 1,252 children had an unhappy outcome, but information about their hospitalizations is an important step in painting a detailed picture about terminal pediatric illnesses. Having such information may help economists and pediatric providers both provide needed care and figure out how to do so without bankrupting families.
1. Himmelstein DU, Thorne D, Warren E, Woolhandler S. Medical bankruptcy in the United States, 2007: Results of a national study. American Journal of Medicine 2009; 122 (8):741-746.