Home | Business News | Browse by Publication | P | Pediatrics

Financing of pediatric home health care *.

Article Excerpt
INTRODUCTION

The home of the pediatric patient is an appropriate and often preferred site for the provision of health care services to address a wide range of conditions. According to national estimates, (1) more than 500 000 children use home health services in the United States. * Children receiving home health care have a diverse array of diagnoses, severity levels, and complications. The 4 most common diagnoses are cerebral palsy, failure to thrive, developmental delay, and preterm birth, accounting for approximately 15% of the pediatric home health population. Although many children receiving home health care depend on technology, the vast majority do not. (2) Research also reveals that young children are more likely to receive home health care than are older children and adolescents. (1)

Over the past 20 to 30 years, the demand for pediatric in-home services has grown substantially as a result of several factors including the increased survival of preterm infants, trauma patients, and those treated in PICUs; medical and surgical treatment advances; miniaturization and simplification of life-sustaining equipment; family preferences for home versus hospital care; and cost-containment pressures to limit or avoid hospital stays. Moreover, home health care has been shown to be a cost-effective alternative to inpatient hospital care. (3-5) Today, the range of services provided to children in the home has broadened to include not only rehabilitative care but also intravenous administration of antimicrobial agents and other medications, parenteral nutrition, nasogastric or enterostomy feedings, peritoneal dialysis, wound care, oxygen and mechanically assisted ventilation, chronic pain management, complex medical and surgical care, psychosocial support, respite, and hospice care. Registered nurses are the primary providers of pediatric home health care under the direct supervision of the physician. (6) Other health professionals providing in-home care to children are physical and occupational therapists, speech pathologists, medical social workers, nutritionists, licensed practical/vocational nurses, home health aides, and personal care aides.

National health expenditure data reveal that pediatric home health costs totaled $5.3 billion in 2000. This represents one fifth of all home health expenditures but less than 1% of all children's health expenditures. On average, the per-child cost of home health care was $9421 and ranged from a low of $70 to a high of $136 969. By far, Medicaid was the major payer of pediatric home health care (77%), followed by other public sources (22%). Private health insurance and families each paid less than 1% of pediatric home health expenditures. (1)

The American Academy of Pediatrics (AAP) recognizes the growing trend to provide health care services for children in their homes. The AAP has issued a policy statement for the provision of home health care services (6) and also a guide on the management of pediatric patients in the home. (2) To advocate for improvements in the financing of pediatric home health care, the AAP has developed this financing policy statement for its members,...