Globe article on the cost of care at Children's

MandellA Boston Globe article this morning brought the cost of care here at Children’s Hospital Boston into question, saying, among other things, that “Children’s charges the highest fees for both outpatient and inpatient care.” It’s based on data by Harvard Pilgrim Health Care (HPHC) that we don’t feel accurately reflects the care that we provide.

While the writer, Liz Kowalczyk, did say that because about 30 percent of our patients are on Medicaid, we have to “make up the lost revenue from private insurers,” I don’t think she went far enough in explaining why our costs tend to be higher than other hospitals in the state.

First and most important, Children’s is the only freestanding children’s hospital on the Globe’s list, so comparing the care we deliver to that of hospitals that primarily care for adults puts us at an automatic disadvantage. Why? Because, fortunately, children get sick much less often than adults, but when they do get sick, it costs much more to care for them.

And when they get very sick or critically injured, they nearly always come to Children’s, which provides the highest level of trauma and neonatal intensive care in the state. The costs associated with this are far from insignificant, given that we treat an amazing 90 percent of the state’s most complex pediatric patients. The HPHC data didn’t distinguish between the care of high-acuity and low-acuity patients, which we refer to as case mix.

One of the reasons pediatric health care is more expensive than adult health care is that we have to keep a lot of equipment - in a wide range of sizes - on hand at all times.
One of the reasons pediatric health care is more expensive than adult health care is that we have to keep a lot of equipment - in a wide range of sizes - on hand at all times. Above are just three of the many blood pressure cuffs used by Children's clinicians.

I realize that health care organizations like Children’s are – and should be – under the microscope regarding the cost of our care. And I applaud the Globe and other media outlets for making sure that all sides in the health care reform debate are accountable to the public. Children’s has worked hard in recent years to control our costs, build greater efficiencies into the way we do business and collaborate with the state’s insurers to ensure that we’re providing the best care at the best prices – even going so far as volunteering to cut our payment rates in FY2010.

But I think it’s critically important that the health care debate take into account the real differences between the care provided at adult hospitals vs. pediatric hospitals, and that the health care system should take a long-term view of “value.” Early and comprehensive intervention in childhood diseases, like asthma, autism and diabetes, is the best societal investment we can make, but one that is often overlooked in the health care cost debate.