Hospitalisations relating to complex conditions, trauma, and sports-related and spinal injury represented the highest costs to the healthcare system.
Paediatric hospitalisations are a “significant cost” to the healthcare system and substantially burden children and their families, according to a new systematic review.
The review of 88 studies published between 1990 and December 2022 noted that novel models of care, such as hospital in the home and family-centred care, may help minimise hospital stays and associated costs, although the authors acknowledged that Australian research was limited.
Senior author Professor Adam Guastella from the University of Sydney’s Brain and Mind Centre said the findings highlighted the need for “co-ordinated hospital-wide approaches to support families during difficult times and to deliver optimal supports that protect children experiencing vulnerability associated with their hospitalisations”.
“Although policy and systems have changed over the 30-year review period, there remain unmet needs and challenges for the healthcare system, across paediatric admissions and for specific cohorts,” the researchers wrote.
The authors drew attention to under-represented hidden hospital costs affecting the patient and their family such as time taken off work to care for children and incidental costs of travel, meals and accommodation, as well as emotional and social disadvantages. A 2018 study estimated that these hidden costs could cost families over $687 per admission.
Direct hospitalisation costs were attributed to medically complex cases, trauma-related hospitalisations and sports and spinal injuries. Despite accounting for a third of all hospital costs, medically complex cases only made up 13.7% of admissions. Further, the estimated cost of sports-related and spinal injury was up to $12,500 per admission.
Overall, costs were higher in younger patients and those with comorbid or/and complex conditions.
Patients in rural and remote areas, from low-socioeconomic backgrounds and/or Indigenous communities were most affected by hospitalisations. Additionally, the treatment of younger children (aged 0-14 years) was significantly more expensive than older children.
Further, the reviewed studies indicated that targeted interventions aimed at high-risk groups such as children with complex conditions or with an intellectual disability, were effective. For example, a targeted care co-ordination program in high-risk cohorts led to less travel and reductions in short-term readmissions.
The success of this program was attributed to “sustainable relationship-building between primary and tertiary care and a well-supported clinical care co-ordination program”, which researchers said were “important factors that must be addressed to effectively mitigate systems and policy changes”.
The authors also emphasised the importance of community education and primary care to prevent hospitalisations in the first place, underlining the value of vaccinations in reducing hospitalisation relating to respiratory conditions.
The review also highlighted gaps in the literature. Little was known about intervention-based programs for children with medically complex conditions, direct and indirect hospitalisation costs for those with mental health or neurodevelopmental conditions, novel models of care in an Australian setting and of indirect hospitalisation costs.
Finally, the researchers acknowledged the review’s limitations: namely methodological differences between studies, lag between the collection of data and publication of findings, and gaps in the literature.
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