Closure of Licensed Pediatric Beds in Health Care Markets Within Illinois

Abstract

Objective: Our objective was to understand the market characteristics related to closures of licensed pediatric hospital beds that may be related to increasing regionalization of pediatric hospital care.

Methods: We performed a retrospective descriptive analysis of 110 hospitals with licensed pediatric hospital beds from a statewide survey of health care facilities (2012-2017) and administrative data of hospital admissions (2013-2018) in Illinois. We quantified closures of licensed pediatric hospital beds and categorized hospital bed closures by hospital and market characteristics.

Results: From 2012 through 2017, the number of licensed pediatric beds declined from 1706 to 1254 (-26.5%). Over the same time period, annual pediatric inpatient days minimally changed (+1.1%), while annual pediatric inpatient days at hospitals affiliated with the Children's Hospital Association increased (+30.5%). After accounting for re-openings, the 33 hospitals that closed all licensed pediatric beds fit 4 distinct typologies: 1) Hospitals with minimal pediatric volume throughout the study (n = 19); 2) Hospitals that sustained at least 50% of their pediatric volume after closure of licensed pediatric beds (n = 8); 3) Hospitals with low market share in metropolitan areas (n = 5); and 4) Hospital with a decline in pediatric market share, while a nearby hospital saw a corresponding rise in pediatric market share (n = 1).

Conclusions: In Illinois, licensed pediatric hospital beds declined while pediatrics inpatient days stayed the same over a recent 6-year period. Typologies of closures describe the nuanced dynamics leading to decline of pediatric hospital beds. Understanding these patterns is critical to ensure that children receive quality pediatric-tailored care.

Keywords: access to care; health care markets; hospital closures; pediatric regionalization.

Figure 1.

Examples of 3 mutually exclusive volume trends for hospitals that closed licensed pediatric beds. Graphs include quarterly admissions data for 1 hospital from each volume trend: 1) lost almost all pediatric volume, 2) maintained pediatric volume, and 3) had negligible volume pre- and postclosure. Hospitals have been anonymized.

Figure 2.

Illustrative example of hospital catchment area and market share. The zip codes that cumulatively comprised the top 80% of the hospital’s pediatric admissions were defined as that hospital’s catchment area. The market share was calculated as the number of admissions to the hospital from the catchment area divided by the total number of admissions to all hospitals from the catchment area. Note: Illustrative example, total admissions to all hospitals (1000) from catchment area (zip codes 1–9) not visualized.