Nonmedical expenses of pediatric hospitalizations have disproportionate effects

1. Caregivers of hospitalized children had median nonmedical expenses and lost wages totaling $51.4 per day of hospitalization.

2. Cost burden as a proportion of income was higher for single parents, those with less education or employment, African Americans, and families reporting financial or social hardship.

Evidence Rating Level: 4 (Below Average)

Study Rundown: Pediatric hospitalizations are costly and time-consuming for families. While the direct medical costs to families is easily measureable, less is known about the nonmedical expenses associated with hospitalization. In this cross-sectional study, researchers used in-person survey data from families of children hospitalized at the Cincinnati Children’s Hospital Medical Center in 2015 and 2016 to measure nonmedical costs to families including lost wages, travel, meals, and child care. The median nonmedical cost to families was $51.4 per day, or 45% of median daily income. Single parents, those with less education or employment, African Americans, and families reporting financial or social hardship had significantly higher cost burdens.

The generalizability of this study may be limited by its sample, which included only English-speakers at a single pediatric institution. Furthermore, survey data may be subject to recall bias. Nonetheless, the study is strengthened by a large sample size that included many demographic groups. For physicians, these findings highlight the importance of identifying children whose care may be impacted by costs, and providing assistance and interventions to mitigate the financial burden on families.

Click to read the study, published today in Pediatrics

Click to read an accompanying editorial in Pediatrics

Relevant reading: Socioeconomic status influences the toll paediatric hospitalisations take on families: A qualitative study

In-Depth [cross-sectional study]: Researchers used in-person survey data from families of 1500 randomly assigned children admitted to the hospital medicine or neurosciences teams at the Cincinnati Children’s Hospital Medical Center between February 2015 and April 2016. Families were excluded if they had a hospital stay ≥2 standard deviations above the mean duration, were surveyed before completing at least 20% of their total length of stay, or were non-English speaking. Survey questions assessed nonmedical costs related to the hospitalization including lost wages, travel, meals, and child care, as well as demographic information and other financial and social hardships. Researchers calculated a daily cost burden (DCB) by extrapolating the sum of nonmedical costs across the entire hospitalization divided by length of stay in days, and a daily cost burden as a percentage of daily income (DCBi) by dividing the DCB by the family’s reported daily income.

The median DCB was $51.4 (IQR: $23.6-159.2) and the median DCBi was 45% (IQR: 12.8%-149.5%). African Americans had the highest DCBi of 70.8% (IQR: 22.1%-190.9%). Single parents, those with less education, and those with less employment had significantly higher DCB and DCBi (p < .01). DCBi was higher for families reporting 1-2 financial hardships (64.5%; IQR: 13.3%-157.7%) or ≥3 financial hardships (86.4%; IQR: 30.7%-214.7%) than for families reporting no financial hardships (14.8%; IQR: 7.1%-54.3%).

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