title: Medicaid, hospital financial stress, and the incidence of adverse medical events for children.
abstract: OBJECTIVE
  To assess the association between Medicaid-induced financial stress of a hospital and the probability of an adverse medical event for a pediatric discharge.
  
  
  METHODS
  Secondary data from the Nationwide Inpatient Sample, Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, and the American Hospital Association's Annual Survey of Hospitals. Study examines 985,896 pediatric discharges (children age 0-17), from 1,050 community hospitals in 26 states (representing 63 percent of the U.S. Medicaid population) between 2005 and 2007.
  
  
  METHODS
  We estimate the probability of an adverse event, controlling for patient, hospital, and state characteristics, using an aggregated, composite measure to overcome rarity of individual events.
  
  
  RESULTS
  Children in hospitals with relatively high proportions of pediatric discharges that are more reliant on Medicaid reimbursement are more likely than children in other hospitals (odds ratio = 1.62) to experience an adverse event. Medicaid pediatric inpatients are more likely than privately insured patients (odds ratio = 1.10) to experience an adverse event.
  
  
  CONCLUSIONS
  Hospital reliance on comparatively low Medicaid reimbursement may contribute to the problem of adverse medical events for hospitalized children. Policies to reduce adverse events should account for differences in underlying, contributing factors of these events.
authors.affiliation: College of Business, University of South Florida St. Petersburg, St. Petersburg, FL 33701, USA. smithrb@usfsp.edu
authors.forename: Richard B
authors.initials: RB
authors.lastname: Smith
authors.forename: Linda
authors.initials: L
authors.lastname: Dynan
authors.forename: Gerry
authors.initials: G
authors.lastname: Fairbrother
authors.forename: Glen
authors.initials: G
authors.lastname: Chabi
authors.forename: Lisa
authors.initials: L
authors.lastname: Simpson
mesh_terms: D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006302:Health Services Research; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics*; D010351:Patient Discharge / Q000191:economics*; D061214:Patient Safety; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D014481:United States