National injury-related hospitalizations in children: public versus private expenditures across preventable injury mechanisms.

BACKGROUND Examination of expenditures in areas where more universal application of effective injury prevention approaches is indicated could identify specific mechanisms and age groups where effective intervention may impact public injury-related expenditures. METHODS The Healthcare Cost and Utilization Project 2003 (KID-HCUP) contains acute care hospitalization data for U.S. children and adolescents residing in 36 states. The study population includes 240,248 unweighted (397,943 weighted) injury-related hospital discharges for ages 0 to 19 years. Injury severity was assessed using ICDMAP-90 and International Classification of Injury Severity Scores (ICISS). SUDAAN was employed to adjust variances for stratified sampling. Expenditures were weighted to represent the U.S. population. RESULTS Injury-related hospitalizations (mean $28,137 +/- 64,420, median $10,808) were more costly than non-injury discharges, accounting for approximately 10% of all persons hospitalized (unweighted), but more than one-fifth of expenditures. Public sources were the primary payor for 37.7% of injured persons. Incidence and cost per case variations across specific injury mechanisms heavily influenced total mechanism specific expenditures. Motor vehicle crashes were the largest expenditures for private and public payors with two thirds of expenditures in teenagers - more than 40% for drivers. Medicaid covered 45.6% ($192 million) of burn expenditures and 59.2% in 0-4 year olds. Expenditures per case (mean +/- SD, median) were: firearm ($36,196 +/- 58,052, $19,020), motor vehicle driver ($33,731 +/- 50,583, $18,431), pedestrian ($31,414 +/- 57,103, $16,552); burns ($29,242 +/- 64,271, $10,739); falls ($13,069 +/- 20,225, $8,610); and poisoning ($8,290 +/- $15,462, $5,208). CONCLUSIONS More universal application of proven injury prevention has the potential to decrease both the public and private health expenditure burden among several modifiable injury mechanisms.