Fewer hospitals are admitting pediatric patients than before the pandemic, according to a study published Nov. 22 in JAMA Network Open.
Many small and medium-sized hospitals have ended pediatric services in recent years amid hospital consolidation, declining Medicaid reimbursements and decreasing pediatric admission volumes. During the pandemic, some hospitals also repurposed their pediatric units to expand adult inpatient capacity.
For the study, researchers at Boston Children's Hospital analyzed 2019 and 2021 data from the Healthcare Cost and Utilization Project's National Inpatient Sample Databases to understand how pediatric admissions changed after the pandemic.
"Our observations suggest that this dynamic accelerated during the COVID-19 pandemic, with an additional loss of one-sixth of the nation's remaining pediatric inpatient services," the researchers said.
Four study findings:
1. Researchers identified 1,795 hospitals that reported at least one pediatric admission in 2021, down 17% from 2,169 hospitals in 2019.
2. Of the 374 hospitals that ended pediatric admissions, nearly half served patient populations where Medicaid accounts for more than 60% of admissions.
3. Private, nonprofit hospitals accounted for 55.1% of facilities that ended pediatric care services, while rural hospitals represented 48.7% and small hospitals 47.6%.
4. The relative decrease in pediatric care was most noticeable in small, private or investor-owned, and urban hospitals without teaching programs. These hospitals experienced the largest percentage drops in pediatric admissions.
"Rapid, uncontrolled closure of pediatric hospital services presents a public health challenge," researchers said. "While some closed pediatric inpatient services may reopen, history and system dynamics suggest that most will become permanent casualties of the pandemic. If so, access to care among vulnerable rural and Medicaid populations will be especially affected."