• Loren Berman, Marjorie S Rosenthal, and R Lawrence Moss.
• Department of Surgery, Yale University School of Medicine, CT 06520-8062, USA.
• J. Pediatr. Surg. 2010 Jan 1; 45 (1): 38-43; discussion 44.

ObjectiveCaring for neonates with major congenital anomalies has significant financial implications for the treating institution, which can be positive or negative depending on whether the patient has insurance. We hypothesized that insured affected neonates born in non-children's hospitals would be more likely to be treated on site, whereas uninsured neonates would be more likely to be transferred.Patients And MethodsWe used the Kids' Inpatient Database to study neonates with congenital anomalies who were born in US non-children's hospitals. We performed bivariate analysis using the chi(2) test and adjusted for covariates with multiple logistic regression.ResultsUninsured patients were 2.57 (95% confidence interval, 1.83-3.62) times more likely to be transferred compared with patients with private insurance or Medicaid, after adjusting for patient and hospital characteristics. This trend increased over time between 1997 and 2006.ConclusionsThe current reimbursement structure in the United States incentivizes non-children's hospitals to retain insured patients with congenital anomalies and transfer uninsured patients with these same anomalies. This places a disproportionate financial burden on children's hospitals while paradoxically causing insured infants to be cared for at hospitals that may not be best equipped to provide complex care.Copyright 2010 Elsevier Inc. All rights reserved.

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