US lost one-sixth of pediatric inpatient services during pandemic
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Key takeaways:
- The number of hospitals with at least one pediatric admission fell 17.2% from 2019 to 2021.
- Small and rural hospitals made up almost half of all closures.
One in six hospitals that accepted pediatric patients in 2019 closed their pediatric services by 2021, according to a study published in JAMA Network Open.
“Early in the COVID-19 pandemic, many hospital pediatric units were repurposed to expand adult capacity,” Urbano L. Franca, PhD, and Michael L. McManus, MD, MPH, faculty members in the department of anesthesiology, critical care and pain medicine at Boston Children’s Hospital, wrote. “The impact of this dynamic on access to pediatric hospital care has not been assessed.”
Franca and McManus used data from the National Inpatient Sample Databases to compare pediatric admissions at U.S. hospitals in 2019 and 2021. They did not include hospitals that care only for infants aged 1 year or younger.
The number of hospitals with at least one pediatric admission fell 17.2% (P < .001) from 2,169 in 2019 to 1,795 in 2021. Out of 374 hospitals that lost pediatric admissions, 55.1% were private nonprofit, 47.6% were small, 48.7% were rural and 48.4% served predominantly Medicare patients. The types of hospitals with the largest proportional decreases in pediatric admissions from 2019 to 2021 were small (–23.8%), private investor-owned (–26.9%) and urban nonteaching hospitals (–32.8%). The proportion of urban teaching hospitals with pediatric admissions increased from 46% in 2019 to 52.4% in 2021 (P < .001).
“Hospital consolidation, falling Medicaid reimbursement, and a decrease in volume of pediatric admissions have intensely pressured small and medium-sized hospitals, causing loss of pediatric services,” the researchers wrote. “Our observations suggest that this dynamic accelerated during the COVID-19 pandemic, with additional loss of one-sixth of the nation’s remaining pediatric inpatient services.”
“While some closed pediatric inpatient services may reopen, history and system dynamics suggest that most will become permanent casualties of the pandemic,” Franca and McManus wrote.
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