Lion K Casey, Wright Davene R, Desai Arti D, Mangione-Smith Rita
Department of Pediatrics, University of Washington, Seattle, Washington; and
Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.
Hosp Pediatr. 2017 Feb;7(2):70-78. doi: 10.1542/hpeds.2016-0051. Epub 2017 Jan 10.
The study goal was to determine whether preferred language for care and insurance type are associated with cost among hospitalized children.
A retrospective cohort study was conducted of inpatients at a freestanding children's hospital from January 2011 to December 2012. Patient information and hospital costs were obtained from administrative data. Cost differences according to language and insurance were calculated using multivariate generalized linear model estimates, allowing for language/insurance interaction effects. Models were also stratified according to medical complexity and length of stay (LOS) ≥3 days.
Of 19 249 admissions, 8% of caregivers preferred Spanish and 6% preferred another language; 47% of admissions were covered by public insurance. Models controlled for LOS, medical complexity, home-to-hospital distance, age, asthma diagnosis, and race/ethnicity. Total hospital costs were significantly higher for publicly insured Spanish speakers ($20 211 [95% confidence interval (CI), 7781 to 32 641]) and lower for privately insured Spanish speakers (-$16 730 [95% CI, -28 265 to -5195]) and publicly insured English speakers (-$4841 [95% CI, -6781 to -2902]) compared with privately insured English speakers. Differences were most pronounced among children with medical complexity and LOS ≥3 days.
Hospital costs varied significantly according to preferred language and insurance type, even adjusting for LOS and medical complexity. These differences in the amount of billable care provided to medically similar patients may represent either underprovision or overprovision of care on the basis of sociodemographic factors and communication, suggesting problems with care efficiency and equity. Further investigation may inform development of effective interventions.
本研究的目标是确定住院儿童接受医疗护理时的首选语言和保险类型是否与费用相关。
对一家独立儿童医院2011年1月至2012年12月期间的住院患者进行了一项回顾性队列研究。患者信息和医院费用来自行政数据。使用多变量广义线性模型估计值计算根据语言和保险的费用差异，同时考虑语言/保险的交互作用。模型还根据医疗复杂性和住院时间（LOS）≥3天进行分层。
在19249例入院病例中，8%的护理人员首选西班牙语，6%首选其他语言；47%的入院病例由公共保险承保。模型对住院时间、医疗复杂性、家到医院的距离、年龄、哮喘诊断以及种族/民族进行了控制。与私人保险的英语使用者相比，公共保险的西班牙语使用者的总住院费用显著更高（20211美元[95%置信区间（CI），7781至32641美元]），私人保险的西班牙语使用者（-16730美元[95%CI，-28265至-5195美元]）和公共保险的英语使用者（-4841美元[95%CI，-6781至-2902美元]）的总住院费用更低。这些差异在医疗复杂性高且住院时间≥3天的儿童中最为明显。
即使对住院时间和医疗复杂性进行了调整，医院费用仍因首选语言和保险类型的不同而有显著差异。向医疗情况相似的患者提供的可计费护理量的这些差异可能表明，基于社会人口因素和沟通情况，护理存在供应不足或过度供应的问题，这暗示了护理效率和公平性方面的问题。进一步的调查可能为有效干预措施的制定提供参考。
