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.

8 thoughts on “Globe article on the cost of care at Children's

  1. On NPR this morning it was stated that one of the reasons for higher charges at Boston teaching hospitals, CHB was named, was the cost of “expensive research”; does the money paid by patients used to fund research at CHB?

  2. On NPR this morning it was stated that one of the reasons for higher charges at Boston teaching hospitals, CHB was named, was the cost of “expensive research”; does the money paid by patients used to fund research at CHB?

  3. Children’s also provides completely unique services, which are expensive to deliver yet vitally important to public health. A case in point is the science-based Adolescent Substance Abuse Program (ASAP). It is the only program of its kind located at a children’s hospital anywhere in the world. Children’s has committed millions to support this program, simply because it is needed: alcohol and drug use are linked to the leading causes of death among teenaged children. ASAP is science-based, leading to stellar outcomes, and turns no child away because of inabiltiy to pay.

  4. The GLOBE might also include in its investigative work that Children’s Hospital of Boston takes care of specialized care for pediatric patients for many states in New England. Connecticut does not have Level 4 Neurological care in our state. Maine, New Hampshire, and Vermont lack many pediatric neurological specialists as well. Parents have a choice between Mass General and Children’s of Boston for specialized care in many specialties including neurology. Smaller facilities exist, but take may take month to get an appointment for your child.

    When comparing the costs of a major teaching hospital that is fully equipped to handle the needs of your complex medical needs for your child, the cost will reflect the facility and staff. A smaller facility may have smaller fees, but may offer less available testing, less up to state of the art facilities for the testing, and staff numbers may be lower.

    If you compare an orange to an apple, you know both deliver nutrition. Both small and large hospitals deliver good services. CHildren’s Hospital of Boston strives to serve children and their specific needs. COmpare the cost to all other hospitals in all the rest of the state and you find a wide variety, but some of the hospitals, such as Harrington Hospital in my back yard. Harrington cannot perform the Video EEG my son has needed 4 times but has received here at CHB. Harrinton cannot give him the pediatric psycho-social services that he has needed for 4 years. THere are no pediatric epilepsy specialists there as there are in Children’s. The cost may be higher, but so is the cost of potenial loss of life. We have come close many times and children’s and the doctors here have guided care to assist us. Doctors in our own state gave up on his care in 2004. Thank you Children’s of Boston. You remain worth the drive for this family.

  5. The GLOBE might also include in its investigative work that Children's Hospital of Boston takes care of specialized care for pediatric patients for many states in New England. Connecticut does not have Level 4 Neurological care in our state. Maine, New Hampshire, and Vermont lack many pediatric neurological specialists as well. Parents have a choice between Mass General and Children's of Boston for specialized care in many specialties including neurology. Smaller facilities exist, but take may take month to get an appointment for your child.

    When comparing the costs of a major teaching hospital that is fully equipped to handle the needs of your complex medical needs for your child, the cost will reflect the facility and staff. A smaller facility may have smaller fees, but may offer less available testing, less up to state of the art facilities for the testing, and staff numbers may be lower.

    If you compare an orange to an apple, you know both deliver nutrition. Both small and large hospitals deliver good services. CHildren's Hospital of Boston strives to serve children and their specific needs. COmpare the cost to all other hospitals in all the rest of the state and you find a wide variety, but some of the hospitals, such as Harrington Hospital in my back yard. Harrington cannot perform the Video EEG my son has needed 4 times but has received here at CHB. Harrinton cannot give him the pediatric psycho-social services that he has needed for 4 years. THere are no pediatric epilepsy specialists there as there are in Children's. The cost may be higher, but so is the cost of potenial loss of life. We have come close many times and children's and the doctors here have guided care to assist us. Doctors in our own state gave up on his care in 2004. Thank you Children's of Boston. You remain worth the drive for this family.

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