Bassett Hannah K, Coller Ryan J, Beck Jimmy, Hummel Kevin, Tiedt Kristin A, Flaherty Brian, Tchou Michael J, Kapphahn Kristopher, Walker Lauren, Schroeder Alan R
Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Deparment of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Hosp Med. 2020 Nov;15(11):652-658. doi: 10.12788/jhm.3500.
High costs of hospitalization may contribute to financial difficulties for some families.
To examine the prevalence of financial distress and medical financial burden in families of hospitalized children and identify factors that can predict financial difficulties.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of parents of hospitalized children at six children's hospitals between October 2017 and November 2018.
The outcomes were high financial distress and medical financial burden. Multivariable logistic regression identified predictors of each outcome. The primary predictor variable was level of chronic disease (complex chronic disease, C-CD; noncomplex chronic disease, NC-CD; no chronic disease, no-CD).
Of 644 invited participants, 526 (82%) were enrolled, with 125 (24%) experiencing high financial distress, and 160 (30%) reporting medical financial burden. Of those, 86 (54%) indicated their medical financial burden was caused by costs associated with their hospitalized child. Neither C-CD nor NC-CD were associated with high financial distress. Child-related medical financial burden was associated with both C-CD and NC-CD (adjusted odds ratio [AOR], 4.98; 95% CI, 2.41-10.29; and AOR, 2.57; 95% CI, 1.11-5.93), compared to no-CD. Although household poverty level was associated with both measures, financial difficulties occurred in all family income brackets.
Financial difficulties are common in families of hospitalized children. Low-income families and those who have children with chronic conditions are at particular risk; however, financial difficulties affect all subsets of the pediatric population. Hospitalization may be a prime opportunity to identify and engage families at risk for financial distress and medical financial burden.
住院费用高昂可能给一些家庭带来经济困难。
调查住院儿童家庭经济困境和医疗经济负担的患病率，并确定可预测经济困难的因素。
设计、地点和参与者：2017年10月至2018年11月期间，对六家儿童医院住院儿童的家长进行横断面调查。
结局为高度经济困境和医疗经济负担。多变量逻辑回归确定了每个结局的预测因素。主要预测变量是慢性病水平（复杂慢性病，C-CD；非复杂慢性病，NC-CD；无慢性病，无-CD）。
在644名受邀参与者中，526名（82%）被纳入研究，其中125名（24%）经历高度经济困境，160名（30%）报告有医疗经济负担。其中，86名（54%）表示其医疗经济负担是由住院儿童的相关费用所致。C-CD和NC-CD均与高度经济困境无关。与无-CD相比，与儿童相关的医疗经济负担与C-CD和NC-CD均相关（调整优势比[AOR]，4.98；95%置信区间[CI]，2.41-10.29；AOR，2.57；95%CI，1.11-5.93）。尽管家庭贫困水平与这两项指标均相关，但各家庭收入阶层均出现了经济困难。
住院儿童家庭经济困难很常见。低收入家庭以及有慢性病患儿的家庭尤其危险；然而，经济困难影响到儿科人群的所有亚组。住院可能是识别和帮助有经济困境和医疗经济负担风险家庭的绝佳时机。
