Department of Surgery, Yale University School of Medicine, CT 06520-8062, USA.
J Pediatr Surg. 2010 Jan;45(1):38-43; discussion 44. doi: 10.1016/j.jpedsurg.2009.10.006.
Caring for neonates with major congenital anomalies has significant financial implications for the treating institution, which can be positive or negative depending on whether the patient has insurance. We hypothesized that insured affected neonates born in non-children's hospitals would be more likely to be treated on site, whereas uninsured neonates would be more likely to be transferred.
We used the Kids' Inpatient Database to study neonates with congenital anomalies who were born in US non-children's hospitals. We performed bivariate analysis using the chi(2) test and adjusted for covariates with multiple logistic regression.
Uninsured patients were 2.57 (95% confidence interval, 1.83-3.62) times more likely to be transferred compared with patients with private insurance or Medicaid, after adjusting for patient and hospital characteristics. This trend increased over time between 1997 and 2006.
The current reimbursement structure in the United States incentivizes non-children's hospitals to retain insured patients with congenital anomalies and transfer uninsured patients with these same anomalies. This places a disproportionate financial burden on children's hospitals while paradoxically causing insured infants to be cared for at hospitals that may not be best equipped to provide complex care.
为患有重大先天畸形的新生儿提供护理对治疗机构有重大的财务影响，具体影响是正面还是负面取决于患者是否有保险。我们假设，在非儿童医院出生的有保险的先天畸形新生儿更有可能在现场接受治疗，而没有保险的新生儿更有可能被转院。
我们使用儿童住院数据库研究了在美国非儿童医院出生的患有先天性畸形的新生儿。我们使用卡方检验进行了双变量分析，并使用多元逻辑回归对患者和医院特征进行了调整。
在调整了患者和医院特征后，与有私人保险或医疗补助的患者相比，没有保险的患者被转院的可能性是其 2.57 倍（95%置信区间，1.83-3.62）。这一趋势在 1997 年至 2006 年间不断增加。
美国目前的报销结构鼓励非儿童医院留住有保险的先天畸形患者，并将同样患有这些疾病的无保险患者转院。这给儿童医院带来了不成比例的财务负担，同时也导致有保险的婴儿在可能无法提供复杂护理的医院接受治疗。
