Hospital length of stay for children and adolescents diagnosed with depression: is primary payer an influencing factor?
OBJECTIVE
This study aimed (a) to discern the distribution by primary payer (public vs. private) of U.S. patients aged 5-18 years who were hospitalized with a primary diagnosis of depression and (b) to discern the mean hospital length of stay and mean charge per day by payer type.


METHODS
The 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database was used for this analysis. Depression was defined as International Classification of Diseases, 9th Revision, Clinical Modification codes 296.2-296.36, 300.4 or 311. Differences in hospital length of stay and mean cost per day by payer type were discerned via adjusted least square mean analysis (+/-S.E.).


RESULTS
The adjusted mean hospital length of stay was significantly higher (P<.0001) for patients with a public payer (6.6+/-0.05 days) versus a private payer (5.3+/-0.05 days). Although statistically significant (P<.0001), the adjusted mean charge per day differed little by payer type (public, US$1316.39+/-9.82; private, US$1357.51+/-9.07).


CONCLUSIONS
Further research is required to discern whether observed differences in hospital length of stay are the result of private payers enhancing patient care, thereby discharging patients in a more efficient manner, or the patients being discharged prematurely from the hospital due to constraints in reimbursement by private payers.
Sclar
David A
DA
Pharmacoeconomics and Pharmacoepidemiology Research Unit, Department of Health Policy and Administration, Washington State University, P.O. Box 646510, Pullman, WA 99164-6510, USA. sclar@mail.wsu.edu <sclar@mail.wsu.edu>
Robison
Linda M
LM
Gavrun
Corrine
C
Skaer
Tracy L
TL
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000145:classification*; D038801:International Classification of Diseases; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D017149:Private Sector; D017150:Public Sector