title: The paradoxical effect of medical insurance on delivery of surgical care for infants with congenital anomalies.
abstract: OBJECTIVE
  Caring for neonates with major congenital anomalies has significant financial implications for the treating institution, which can be positive or negative depending on whether the patient has insurance. We hypothesized that insured affected neonates born in non-children's hospitals would be more likely to be treated on site, whereas uninsured neonates would be more likely to be transferred.
  
  
  METHODS
  We used the Kids' Inpatient Database to study neonates with congenital anomalies who were born in US non-children's hospitals. We performed bivariate analysis using the chi(2) test and adjusted for covariates with multiple logistic regression.
  
  
  RESULTS
  Uninsured patients were 2.57 (95% confidence interval, 1.83-3.62) times more likely to be transferred compared with patients with private insurance or Medicaid, after adjusting for patient and hospital characteristics. This trend increased over time between 1997 and 2006.
  
  
  CONCLUSIONS
  The current reimbursement structure in the United States incentivizes non-children's hospitals to retain insured patients with congenital anomalies and transfer uninsured patients with these same anomalies. This places a disproportionate financial burden on children's hospitals while paradoxically causing insured infants to be cared for at hospitals that may not be best equipped to provide complex care.
authors.affiliation: Department of Surgery, Yale University School of Medicine, CT 06520-8062, USA.
authors.forename: Loren
authors.initials: L
authors.lastname: Berman
authors.forename: Marjorie S
authors.initials: MS
authors.lastname: Rosenthal
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Moss
mesh_terms: D034861:Abdominal Wall / Q000002:abnormalities / Q000601:surgery; D000013:Congenital Abnormalities / Q000191:economics / Q000601:surgery*; D004469:Economics, Hospital; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics; D007363:Intensive Care Units, Neonatal / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics; D017057:Medically Uninsured / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000191:economics; D012052:Reimbursement, Incentive / Q000191:economics; D012959:Socioeconomic Factors; D014481:United States