Indirect Costs of Hospitalizations for Acute Pediatric Care

The 30 day rate of hospital readmission has become a common measure of the quality of care provided by hospitals. Medicare, Medicaid, and other payers have recently set up payment schemes that incentivize hospitals to lower readmission rates. While readmission rates are important to payers and hospitals, in focus groups conducted with families as part of the Hospital to Home Outcomes (H2O) Study, we found that other outcomes, such as the indirect costs of hospitalizations, were more relevant to families than readmission. As part of the H2O Study, we surveyed, prior to discharge, 993 caregivers of children who were hospitalized at a large Midwestern Children’s Hospital for acute reasons.  The children had a median age of 2.1 years, and their caregivers were 91% female, had a median age of 32 years; 47% were married. Of those surveyed, 81% of patients had more than one caregiver. Of those with two caregivers, both worked in 74% of the cases (both worked full time 29% of the time). We asked the caregivers questions regarding the indirect costs of the hospitalization related to lost income from missed work, parking and transportation costs, meals, childcare for other children, and additional costs. We then assessed whether both income loss and overall costs were different by household composition, work status of parents, race, household financial strain, income, and whether they resided in census tracts with >20% of residents living in poverty. We found average indirect costs due to the hospitalizations to be approximately $416 and if income loss was present it accounted for nearly 80% of overall indirect costs. We found statistically significant differences by length of stay, parental marital status, number of adults living in the house, if both caregivers are working, and whether caregiver work schedule allowed for flexibility.