COMPARISON OF INPATIENT CHARGES BETWEEN ACADEMIC AND NONACADEMIC SERVICES IN A CHILDRENS-HOSPITAL

Objective. To compare inpatient hospital charges generated within a ch ildren's hospital by academic and nonacademic pediatric services for c ommon medical diagnoses. Methods. Hospital admissions to a free-standi ng children's hospital between 9/1/90 and 8/30/94 were selected for pa tients who were hospitalized 1 to 14 days, with one of six selected di agnoses, and with discharge attending of record either a private pedia trician or an academic sub-specialist. Discharge diagnoses, based on I CD-9 codes, included asthma (n = 1983), bronchiolitis (n = 692), gastr oenteritis (n = 733), rule out sepsis (n = 1065), urinary tract infect ion (n = 516), and viral meningitis (n = 288). Charges associated with patient records were dichotomized as above or below the median charge for each diagnostic category. Each category was analyzed separately u sing a logistic regression model where the dichotomous-dependent varia ble was charges above the median charge for each diagnosis. Independen t variables included physician type, payor status, patient residence, ICD-9 code as primary or secondary diagnosis, patient age, and presenc e of complicating conditions. Results. By univariate comparison, acade mic physicians cared for a higher percentage of underinsured patients, and their care was more expensive. Complicated claims were associated with higher charges than uncomplicated claims for all diagnostic cate gories. Academic and nonacademic physicians were equally likely to gen erate above-median charges for five of the six diagnostic categories w hen controlling for confounding factors. A Linear regression model in which charge was the dependent variable generated similar results. Con clusions. Within the same pediatric health care facility, no consisten t difference was found between charges incurred on academic vs private inpatient services.