Charges for childhood asthma by hospital characteristics

Background. The ownership, location, and teaching status of hospitals affec t their missions, policies, finances, and operations. Objective. This study assesses the relationship of hospital ownership, loca tion, 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 less than or equal to 18 y ears of age with the principal diagnosis asthma in 1994 were extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, p roviding a stratified sample of 735 nonfederal, acute-care hospitals In 17 states. Multiple regression analysis on log transformed data was used to ca lculate mean total charges and average length of stay (ALOS) after adjustin g for illness severity and mortality risk (four All Patient Refined-Diagnos is Related Group classes based on secondary diagnoses and procedures); paye r (Medicaid, private, uninsured, other); patient age, sex, income (four cat egories based on ZIP code of residence); state; bed size (three categories varying by location); hospital ownership; location; teaching status; and ad mission month. Results. Asthma severity did not differ significantly by hospital location or teaching status. Nonprofit hospitals treated a slightly higher proportio n of children with major or extreme severity asthma than either public or f or-profit hospitals. Urban teaching hospitals treated more children with as thma who lived in low-income neighborhoods, were uninsured, or received Med icaid coverage than urban nonteaching hospitals. For-profit hospitals admit ted fewer children with asthma from low-income areas than did public hospit als. The ALOS was 2.5 days and did not differ significantly by hospital own ership, location, or teaching status. However, the mean total charges, afte r adjusting for all other significant covariates, was higher at for-profit ($4203) than at nonprofit ($3640) or public hospitals ($3620). Average char ges also were higher at urban teaching ($4230) and lower at rural instituti ons ($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. Implic ations. Additional clinical and outpatient data are needed to study variati ons 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 polic ies are required for financing hospitals that care for a disproportionate s hare of economically disadvantaged children.