title: Do declining private insurance coverage rates influence pediatric hospital charging practices?
abstract: OBJECTIVE
  To analyze trends in primary payer composition for pediatric hospitalizations and insurance coverage rates from 2000 to 2006 and possible effects on hospital charging practices.
  
  
  METHODS
  We documented national trends in hospital charge-to-cost ratios and primary payer mixes for pediatric discharges from 2000 to 2006 using the Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID). We then performed regression analyses at the hospital level to analyze associations between pediatric insurance coverage rates and hospital charge-to-cost ratios.
  
  
  RESULTS
  We found pediatric inpatient charge-to-cost ratios increased dramatically during study period. Charge-to-cost ratios were higher for hospitals located in states with either higher uninsurance rates or a public-private coverage mix that was skewed towards public coverage.
  
  
  CONCLUSIONS
  This study provides evidence of both important changes in pediatric health insurance distribution in the United States and hospital charging practices.
authors.affiliation: The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA. David.Hains@nationwidechildrens.org
authors.forename: David S
authors.initials: DS
authors.lastname: Hains
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Reagan
authors.forename: William E
authors.initials: WE
authors.lastname: Smoyer
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data; D017722:Hospital Charges / Q000592:standards*; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000592:standards*; D007348:Insurance, Health / Q000191:economics*; D014481:United States