ArticleBMC pediatrics2025
Characteristics and related factors of high-need high-cost children in Shanghai, China: a retrospective cohort study in inpatient setting.
Article in BMC pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHigh-need high-cost (HNHC) patients account for a substantial portion of healthcare expenses, experience heavy economic burdens, and have poor health outcomes. Despite their importance, limited research exists on the characteristics and determinants of HNHC pediatric patients in China. This study aims to describe these characteristics and identify factors associated with HNHC status in hospitalized children.
methodsThis retrospective cohort study analyzed data from 2017 to 2023 in Shanghai using two claims databases. HNHC patients were defined as the top 5% by annual standardized cost. The descriptive statistical analysis and Mann-Whitney U test to describe and examine the differences in characteristics between the HNHC group and non-HNHC group. To explore the factors related to HNHC, a generalized linear model is utilized using binary distribution to examine patient, healthcare utilization, and hospital factors related to HNHC status.
resultsA total of 688,131 children were hospitalized during the seven years. 34,410 HNHC patients demonstrated distinct profiles compared to 653,721 non-HNHC patients, who were more likely to be under 1 or over 13 years old, female, Shanghai residents, and well-insured, with emergency admissions, transfers from other hospitals, and had surgeries, longer hospital stays, and more annual hospitalizations. HNHC spending consistently accounted for over 35% of total expenditures annually. The proportion of HNHC patient spending to the total spending remained over 35% across different years. Factors significantly associated with HNHC status included age, single insurance coverage, emergency or transferred admission, surgical intervention, longer hospital stays, more hospitalizations, and hospital characteristics such as tertiary-level, suburban location, and lack of specialization in pediatric healthcare.
conclusionThese findings underscore the necessity to expand medical coverage, enhance financial risk protection, address HNHC-related diseases, and optimize the allocation of pediatric medical resources in the multi-level healthcare system for pediatric patients in China.
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