Hospital Consolidation Tied to Loss of Inpatient Pediatric Services

Joining a health system was associated with a loss of inpatient pediatric services at hospitals, suggesting hospital consolidation can impact access to care for children, a study published in JAMA Pediatrics found.

Inpatient pediatric services have become centralized over the past few decades, perhaps due to the high number of closures of pediatric inpatient units at small, rural hospitals.

As hospital consolidation accelerates, researchers from the University of Pittsburgh School of Medicine sought to determine if joining a hospital system leads to closures of pediatric units to reduce costs or presents an opportunity for small facilities to keep these units open.

Researchers used the American Hospital Association (AHA) annual surveys from 2011 to 2020 to gather data on general and pediatric hospitals across the country. They assessed 5,104 hospitals representing 46,841 hospital-years. Between 2011 and 2020, the share of hospitals providing inpatient pediatric services declined from 41.5 percent to 32.6 percent.

The primary analysis included 1,088 hospitals, 235 of which (21.6 percent) joined a hospital system during the study period. Hospitals that joined a system were more likely to stop providing inpatient pediatric services within five years, with an adjusted odds ratio of 1.57.

When following up with hospitals after four years, the association stayed statistically significant but was not apparent at shorter follow-up lengths.

The findings suggest that hospital consolidation exacerbates the limited availability of inpatient pediatric services in the US. Policymakers should consider the potential loss of these services when reviewing proposed hospital mergers and acquisitions, researchers said.

Additional research should focus on how inpatient unit closures impact access to pediatric acute care, if the effects of consolidation vary by consolidation type, and how hospital consolidation affects child health outcomes and costs.

Past studies have shown differing consequences of healthcare mergers and acquisitions. For example, one study found that hospital mergers were associated with decreased mortality rates for myocardial infarction, heart failure, acute stroke, and pneumonia at rural hospitals.

According to AHA, hospital mergers and acquisitions also reduce healthcare costs, including operating expenses and revenue per admission at hospitals.

However, hospital mergers can hurt market competition and lead to facilities raising their prices, AHIP maintains. Another study found that hospital acquisitions did not have any impact on quality of care measures, including hospital readmissions and mortality rates.