Association of Children’s Hospital Status With Value for Common Surgical Conditions

Abstract

Although children’s hospitals (CH) comprise less than 5% of hospitals in the United States, CH account for 40% of pediatric inpatient days and 50% of costs for pediatric care.¹ CH often provide high-volume, specialized, and resource-intensive care to children who require highly trained clinicians and innovative technologies. One example is congenital heart surgery where mortality rates are lowest at high-volume, specialized centers.^2,3 For this type of highly specialized pediatric care, the value proposition of higher costs at CH is arguably justified by demonstrable improved outcomes and quality.⁴ In 2009, 40 freestanding CH accounted for greater than $10 billion of annual US health care expenditure, and the top 10 CH profited more than $800 million.⁵ Contemporary pediatric care has witnessed substantial regionalization in the last decade, and there are efforts underway to centralize the delivery of children’s surgical care to specialized centers.^6-9