pediatrics
December 2017, VOLUME140 /ISSUE Supplement 3

Practice Patterns in Medicaid and Non-Medicaid Asthma Admissions

JH Silber, PR Rosenbaum, W Wang. Pediatrics. 2016;138(2):e20160371
  1. Christopher Randolph, MD
  1. Waterbury, CT

PURPOSE OF THE STUDY.

To evaluate any differences in practice patterns between Medicaid and non-Medicaid patients admitted for asthma at 40 Children’s Hospital Association hospitals that contribute to the Pediatric Hospital Information System database.

STUDY POPULATION.

This cohort consisted of 17 739 matched pairs of children (Medicaid and non-Medicaid) admitted for asthma at the same institution between April 1, 2011, and March 31, 2014.

METHODS.

A matched-cohort design was used, matching pairs of Medicaid and non-Medicaid children admitted to the same hospital for age, sex, asthma severity, and other patient factors.

RESULTS.

The median cost for Medicaid patients was higher than for non-Medicaid patients ($4263 vs $4160; P < .001), but the median cost difference between matched pairs was $84 (95% CI $44–$124). The costs for admissions at the 90th percentile were comparable ($10 710 vs $10 948; P < .07). Length of stay (LOS) was similar, and rates of ICU admission were comparable (10.1% vs 10.6%; P = .12).

CONCLUSIONS.

In a closely matched cohort of children within the same hospital, Medicaid status did not significantly impact expenses, LOS, or ICU utilization.

REVIEWER COMMENTS.

This was a large study encompassing >17 000 pairs of patients, and while there was a statistically significant difference between Medicaid and non-Medicaid patient hospitalization costs, the differences were insignificant from the clinical and economic perspectives. While some studies report that hospital length of stay is greater for Medicaid patients, this study did not find this to be the case, concluding that insurance status does not significantly impact expenses, length of stay, or ICU use.