Pediatrics and profits: Why children’s hospital units are closing

This past summer, Boston’s pediatric care was thrown in disarray as Tufts Children’s Hospital closed its doors. As Tufts prioritized its need for increased capacity for adult critical care, pediatric patients were sent elsewhere and incoming pediatric residents were left stranded without a hospital to host them. 

Tufts isn’t the only hospital to shift focus away from children’s care. Across the nation, pediatric units are being shuttered in favor of more lucrative units for adult care. Hospitals like Tufts are quick to point out the need for more beds for critically ill adults but fail to mention that this also improves their profit margins. The impacts of this switch are compounded by the surge in respiratory viruses which has caused the remaining children’s beds to fill up quickly. While increased adult beds may meet the COVID-centric moment we’re still in, the closing of children’s units and hospitals across the nation will have wide-ranging, long-term impacts that we will have to reckon with over the coming years.

Why hospital beds for kids are less lucrative

Many hospitals, especially those that are smaller and in rural areas, are struggling financially. When budgets get tight, we see more profitable specialties like oncology and surgery prioritized, while less lucrative specialties like obstetrics and pediatrics are cut. Access to maternal health care, for example, has dropped precipitously due to cuts and has resulted in larger swaths of the country being classified as “maternity care deserts.”

Why is pediatrics a drain on hospital finances? One reason is reimbursement. Medicaid, the state-run health insurance program for low-income patients, covers more than ⅓ of children in the US, and Medicaid reimbursement rates are typically lower than those from other insurers.

But even kids covered under commercial insurance are often less profitable than adults because they have little need for elective surgeries. Elective procedures like joint replacements or heart surgeries, which are profitable for hospitals, are much more common among older adults. Low-value imaging tests are also less common for kids because pediatricians often try to avoid unnecessary radiation — that’s less money for the hospital too. 

The consequences of underinvesting in pediatric care

When no kids’ hospital beds are available, parents may be guided to bring their children to the emergency room instead. This increases the patient flow through already-overcrowded emergency departments, slowing down the rate of care and increasing the burden on staff as the unit becomes progressively more overcrowded. Alternatively, parents can go to the next closest pediatric hospital. In a metropolitan area like Boston, there is still Boston Children’s Hospital and, if necessary, Hasbro Children’s Hospital in Providence. But in rural areas like northeast Oklahoma, choices are limited. And if it takes hours to reach the nearest pediatric specialist with access to the necessary equipment, what are parents to do in an emergency?

Consider the long-term impacts of pediatric unit closures on children with chronic conditions. According to the New York Times, patients in Oklahoma are forced to drive to Memphis, St. Louis, and Rochester just to get their kids the care they need. Hours of travel time, thousands of dollars spent on gas and housing, and the stress of making regular appointments can be too much for patients and lead them to ration or abstain from care altogether. Postponing care can obviously exacerbate sick children’s health problems, but without support for travel, many families have no choice. This can have obvious and immediate consequences, but what other choice do families have? 

We’re headed in the wrong direction. The fact that hospitals feel forced to close down crucial units is indicative of the broken system in which we’re operating. Children are supposedly the most prized population among us, they’re supposed to be protected and cared for all the way through their development. What does it say about our true priorities if even the youngest, most vulnerable members of society are deprioritized for financial reasons? If children are the future, our health system needs to treat them like they matter.