Costs of Care for Hospitalized Children Associated With Preferred Language and Insurance Type

Abstract

Objective To determine whether preferred language for care and insurance type are associated with cost among hospitalized children. Methods We conducted a retrospective cohort study of inpatients at a freestanding children’s hospital from 1/2011 to 12/2012. Patient clinical and demographic information and hospital costs were obtained from administrative data. Cost differences by language and insurance were calculated based on multivariate generalized linear model estimates, which allowed for language-insurance interaction effects. Models were also stratified by medical complexity and length of stay (LOS) ≥3 days. Results Of 19,249 inpatient admissions, 8% preferred Spanish, 6% preferred another language, and 47% had public insurance. Models controlled for LOS, medical complexity, distance from home to hospital, age, asthma diagnosis, and race/ethnicity. Compared to privately-insured English speakers, total hospital costs were significantly higher for publicly-insured Spanish speakers (+$20,211 [95% CI +$7781, +$32,641]), and lower for privately-insured Spanish speakers (−$16,730 [−$28,265, −$5195]) and publicly-insured English speakers (−$4841 [−$6781, −$2902]). A similar pattern was found for pharmacy costs. Differences were most pronounced among children with medical complexity and with LOS ≥3 days. Conclusions Hospital costs varied significantly by preferred language and insurance type, even after adjusting for LOS and medical complexity. These differences in the amount of billable inpatient care provided to medically similar patients may represent either under- or over-provision of care on the basis of sociodemographic factors and communication, suggesting problems with care efficiency and equity. Further investigation into the causes may inform development of effective interventions.

Inpatient Communication Barriers and Drivers When Caring for Limited English Proficiency Children

“…1 While most immigrant children are fluent in English, approximately 40% live with a parent who has limited English proficiency (LEP; ie, speaks English less than "very well"). 2,3 In pediatrics, LEP status has been associated with longer hospitalizations, 4 higher hospitalization costs, 5 increased risk for serious adverse medical events, 4,6 and more frequent emergency department reutilization. 7 In the inpatient setting, multiple aspects of care present a variety of communication challenges, 8 which are amplified by shift work and workflow complexity that result in patients and families interacting with numerous providers over the course of an inpatient stay.…”

Identifying Modifiable Health Care Barriers to Improve Health Equity for Hospitalized Children

“…18,47 Each could plausibly contribute to the worse outcomes observed across studies for low-income and minority children. [1][2][3][4][5][6][7][8][9][10] Our results highlighted 4 specific caregiver-reported barriers as promising for intervention: the system as a barrier, skill barriers, marginalization barriers, and cultural distance.…”

“…Children from families with low income, of minority race and/or ethnicity, and with limited English proficiency (LEP) are at increased risk for worse outcomes after hospitalization, with longer length of stay (LOS), greater risk of readmission, and worse health-related quality of life (HRQL) compared with other children. [1][2][3][4][5][6][7][8][9][10][11] However, the mechanisms by which these disparities occur are incompletely understood. Many factors likely contribute, occurring both within and outside the health care system and before and after hospital arrival.…”

A sequential, multiple assignment randomized trial comparing web-based education to mobile video interpreter access for improving provider interpreter use in primary care clinics: the mVOCAL hybrid type 3 study protocol

“…Twenty-five million people in the United States of America (USA) report speaking English less than "very well" and, as a result, have limited access to safe and high-quality medical care [1,2]. Language barriers in healthcare are associated with lower patient comprehension, adherence, and satisfaction [3][4][5][6]; higher costs, longer hospital stays, and increased odds of readmission [7][8][9][10][11]; less treatment for pain [12,13]; increased risk of serious adverse events [14][15][16][17]; and increased mortality [18]. Given the importance of effective communication to high-quality medical care, improving communication with patients who use a language other than English for medical care has been named a national priority [19].…”