Medicaid Is Billed for Half of All Children Hospitalized for Congenital Heart Defects

AHRQ News and Numbers

Release date: January 18, 2006

State Medicaid agencies were billed by hospitals for more than $683 million in 2003 for treating children born with heart defects, according to the Federal Agency for Healthcare Research and Quality (AHRQ). This sum represents roughly half the $1.4 billion charged for all hospital patients treated for disorders resulting from congenital heart defects.

• There were over 38,000 hospital admissions for congenital heart defects, and more than half involved children.
• Infants less than 1 year of age accounted for over 30 percent of all hospitals stays for congenital heart defects.
• Medicaid was billed for 49 percent of all hospital stays for congenital heart defects.
• Private health insurers were billed for 43 percent all hospital stays for congenital heart defects.
• The balance was charged mostly to individuals, such as parents of hospitalized children, or written off as uncompensated care.
• The price tag for the average hospital stay for a child born with a heart defect was more than $73,000, and if the child was an infant the average charge rose to $85,000.
• The statistics for total and average hospital charges do not include doctors' fees since they bill separately.
• About 5.5 percent of children admitted for treatment of a congenital heart defect died while in the hospital.

This information was produced using HCUPnet, an online query system that provides access to health statistics and information on hospital stays from AHRQ's Healthcare Cost and Utilization Project (HCUP). This project comprises a family of health care databases and related software tools developed through a Federal-State-industry partnership and sponsored by AHRQ. HCUP includes the largest set of publicly available databases on all patients in the United States, regardless of type of insurance or whether the patients had insurance. To access HCUPnet, go to http://hcupnet.ahrq.gov/.

To speak with an AHRQ expert regarding HCUP data, contact Bob Isquith at BIsquith@ahrq.gov or call (301) 427-1539.

Internet Citation:

Medicaid Is Billed for Half of All Children Hospitalized for Congenital Heart Defects. AHRQ News and Numbers, January 18, 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/nn/nn011806.htm