Macro-Environmental Analysis: Health Insurance for Children

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Table of Contents

Summary
Specific research topic
Proposed focused research question
Identifying contributions
Proposed research designs
Data Sources
References

Summary

Health insurance for children is one of the sore topics actively discussed at various levels of government and in wide circles of the American public. Along with this problem, the issue of the autonomy of children’s hospitals, in contrast to institutions based on complexes for adults, stands out. Several factors draw attention to this aspect, including disappointing infant mortality statistics. The data showed a clear positive trend: child mortality has steadily declined in all countries under review. However, in the US, since about the 1980s, it has been higher than in other countries (Snyder, 2020). Even though America spends more money on the fight against child mortality per capita than other countries, the problem remains relevant even on the current agenda.

These factors can discredit the country’s medicine and have negative consequences for demographic indicators and social and economic aspects of development. Appropriate institutions are needed for a comprehensive solution to this problem in which professionals and experts in their subject areas will work. The child’s body requires special attention and more frequent and specialized prevention, for which appropriate human and hardware resources should be allocated in the right amount. The creation of such institutions is an essential but highly costly task.

Little attention has been paid in the scientific literature to the advantages of such institutions, in contrast to adult systems-owned children’s hospitals. This opposition is necessary to demonstrate the effectiveness of a specialized medical institution in the context of children’s health. However, projects to open, support, and update such hospitals are subject to several macro-environmental factors that, to varying degrees, may hinder the solution of this task. First of all, these are topical issues of financing, which, on the one hand, were redistributed in favor of medicine after the start of the coronavirus pandemic; on the other hand, their application was narrow and did not adequately address this problem (Gaffney et al., 2020). Due to the more excellent coverage, complex institutions are more beneficial from the public’s point of view since differentiated buildings require more operating costs than integrated ones.

However, if considered more globally and in the long term, given the problem of high infant mortality in the United States, professional medical care for children is essential from the point of view of the prospects for the development of society. Health is extremely sensitive to negative influence factors from childhood, and most chronic diseases can be acquired at this age. Specialized institutions will be able to devote more time and opportunity to studying the root of the problem, contributing to the development of a healthy society from the earliest age of its representatives. The impact on social and environmental factors of the macro-environment will be favorably reflected.

Updating technologies and approaches is a fundamental aspect of the successful operation of a medical institution. Specialized children’s hospitals can create a base for research activities in this area to stimulate more technological progress. While these macro-environmental factors may be an obstacle in the early stages of project approval for such institutions, there are no savings on this issue. The legal field of activity will concern the possibility of obtaining access for the majority of children to medical services. The challenge of children’s health insurance must be addressed in the context of the high cost of medical services and medicines, the main problem in the United States, from the point of view of most Americans (He et al., 2022). First of all, these issues require additional funding to stimulate progress on the tasks; however, to attract attention, it is necessary to prove the effectiveness of specialized children’s institutions over other hospitals, according to existing data.

Specific research topic

This topic analysis will be conducted to compare free-standing children’s hospitals (classified by AHA/CHA) to adult systems-owned children’s hospitals (classified as hospitals within the hospital model). A “children’s hospital” would be defined as a hospital that only provides care to children and hospitals with key pediatric services, including pediatric emergency departments, PICUs, and NICUs.

Understanding the comparison aims to evaluate free-standing children’s hospitals’ future financial and operational viability. Free-standing children’s hospitals are at risk because of poor financial performance, low financial reserves, increased costs in pediatric subspecialty providers, and high dependence on federal and state funding. Using the macro-environmental analysis lens of political, economic, sociocultural, technological, legal, and environmental factors future financial viability of free-standing children’s hospitals will be examined. There is limited research literature regarding the differences in free-standing and adult system-owned children’s hospitals.

Proposed focused research question

Based on this gap in the literature, the question of “what are the barriers to free-standing children’s hospitals remaining independent as reported in the research literature?”. Additional sub-questions to be evaluated will be:

Will the free-standing children’s hospitals go the way of rural hospitals and become obsolete?
How long can they hold out before being acquired by an adult system?

Identifying contributions

Specialized pediatric healthcare provided in children’s hospitals is essential to provide quality care to the most vulnerable patients. According to the Center for American Progress in 2021, nearly 11 million children are in poverty in the United States. Children’s hospitals provide specialty care to all children, regardless of their ability to pay, including those at poverty levels. Rather than a children’s hospital closing pediatric services, it would be beneficial to predict the performance of the free-standing children’s hospitals in advance of financial and operational failures so that an acquisition from a system could be considered to continue to provide quality pediatric care in that region.

Proposed research designs

The research will use regression analysis to compare free-standing and adult system-owned children’s hospitals with the variables: financial performance, pediatric bed count, market share, and the number of services and then a subset of high-end services (pediatric sub-specialist medical services).

Data Sources

2008–2018 American Hospital Association (AHA) Annual Survey
2008–2018 Healthcare Cost Report Information System from the Centers for Medicare & Medicaid Services
2008–2016 HCUPnet state hospitalization counts
2009–2018 American Community Survey 5-year
CHA service line analysis
990’s
PubMed search

References

Abelson, R. (2021). Buoyed by federal covid aid, big hospital chains buy up competitors. The New York Times.

Casimir, G. (2019). Why children’s hospitals are unique and so essential. Frontiers in pediatrics, 305.

Crosby, A., Knepper, H. J., & Levine, H. (2020). PREDICTING HOSPITAL CLOSURE USING POPULAR FINANCIAL INDICATORS: AN EXPLORATORY STUDY OF MUHLENBERG HOSPITAL. Public Administration Quarterly, 44(1).

Cushing, A. M., Bucholz, E. M., Chien, A. T., Rauch, D. A., & Michelson, K. A. (2021). Availability of pediatric inpatient services in the United States. Pediatrics, 148(1).

Franz, B., & Cronin, C. E. (2020). Are Children’s Hospitals Unique in the Community Benefits They Provide? Exploring Decisions to Prioritize Community Health Needs Among U.S. Children’s and General Hospitals [Brief Research Report]. Frontiers in Public Health, 8.

Gaffney, A., Himmelstein, D. U., & Woolhandler, S. (2020). COVID-19 and US health financing: perils and possibilities. International Journal of Health Services, 50(4), 396-407.

Gaynor, M., & Vogt, W. B. (2003). Competition among hospitals. In: National Bureau of Economic Research Cambridge, Mass., USA.

Haider, A. (2021). The basic facts about children in poverty. Center for American Progress, January, 12.

Horwitz, J., & Nichols, A. (2007). What do nonprofits maximize? Nonprofit hospital service provision and market ownership mix. In: National Bureau of Economic Research Cambridge, Mass., USA.

He, G., Li, C., Wang, S., Wang, H., & Ding, J. (2022). Association of insurance status with chronic kidney disease stage at diagnosis in children. Pediatric Nephrology, 1-10.

Kutscher, B. (2015). Competing for kids. Children’s hospitals face challenge from emerging megasystems. Modern Healthcare, 45(33), 32-34.

Moore, B. J., Freeman, W. J., & Jiang, H. J. (2019). Costs of pediatric hospital stays, 2016: statistical brief# 250.

Piper, K. N., Baxter, K. J., McCarthy, I., & Raval, M. V. (2020). Distinguishing Children’s Hospitals From Non–Children’s Hospitals in Large Claims Data. Hospital Pediatrics, 10(2), 123-128.

Romano, M. (2004). The kids are alright. There’s a new brood of children’s hospitals being built, and they’re seeing higher patient volumes even as general acute-care facilities experience a continuing decline in pediatric cases. Modern Healthcare, 34(30), 25-26, 28, 30.

Snyder, B. (2020). The United States paid parental leave and infant mortality. International Journal of Sociology and Social Policy, 40(1/2), 145-153.

Stang, A. S., & Joshi, A. (2006). The evolution of freestanding children’s hospitals in Canada. Paediatrics & Child Health, 11(8), 501-506.

VonAchen, P., Davis, M. M., Cartland, J., D’Arco, A., & Kan, K. (2021). Closure of Licensed Pediatric Beds in Health Care Markets Within Illinois. Academic Pediatrics.

Wishner, J., Solleveld, P., Rudowitz, R., Paradise, J., & Antonisse, L. (2016). A look at rural hospital closures and implications for access to care: three case studies. Kaiser Family Foundation [Internet].

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