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

Abstract

Objective: The study goal was to determine whether preferred language for care and insurance type are associated with cost among hospitalized children.

Methods: A retrospective cohort study was conducted of inpatients at a freestanding children's hospital from January 2011 to December 2012. Patient information and hospital costs were obtained from administrative data. Cost differences according to language and insurance were calculated using multivariate generalized linear model estimates, allowing for language/insurance interaction effects. Models were also stratified according to medical complexity and length of stay (LOS) ≥3 days.

Results: Of 19 249 admissions, 8% of caregivers preferred Spanish and 6% preferred another language; 47% of admissions were covered by public insurance. Models controlled for LOS, medical complexity, home-to-hospital distance, age, asthma diagnosis, and race/ethnicity. Total hospital costs were significantly higher for publicly insured Spanish speakers ($20 211 [95% confidence interval (CI), 7781 to 32 641]) and lower for privately insured Spanish speakers (-$16 730 [95% CI, -28 265 to -5195]) and publicly insured English speakers (-$4841 [95% CI, -6781 to -2902]) compared with privately insured English speakers. Differences were most pronounced among children with medical complexity and LOS ≥3 days.

Conclusions: Hospital costs varied significantly according to preferred language and insurance type, even adjusting for LOS and medical complexity. These differences in the amount of billable care provided to medically similar patients may represent either underprovision or overprovision of care on the basis of sociodemographic factors and communication, suggesting problems with care efficiency and equity. Further investigation may inform development of effective interventions.

Figure 1

Adjusted relative differences in total costs in 2012 US dollars for language and insurance categories. The reference category denoted by the dotted line is privately insured English speakers. Results are adjusted for length of stay, race/ethnicity, distance from hospital, medical complexity, asthma diagnosis, age category, insurance type, preferred language, and the interaction between insurance and language. Bars represent 95% confidence intervals.

Figure 2

Adjusted relative ratios for total, pharmacy, laboratory, and radiology costs, by language and insurance groups. See Appendix for relative ratio values with 95% confidence intervals and P-values. Relative ratios are compared to privately-insured English speakers, denoted by the center line. Results are adjusted for length of stay, race/ethnicity, distance from hospital, medical complexity, asthma diagnosis, age category, insurance type, preferred language, and the interaction between insurance and language. Bars represent 95% confidence intervals.

Figure 3

Adjusted relative ratios for total costs, stratified by complex chronic illness, by language and insurance groups. See Appendix for relative ratio values with 95% confidence intervals and P-values. Relative ratios are compared to privately-insured English speakers, denoted by the center line. Results are adjusted for length of stay, race/ethnicity, distance from hospital, asthma diagnosis, age category, insurance type, preferred language, and the interaction between insurance and language. Bars represent 95% confidence intervals.