Hospital Discharges, by Source of Payment
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- Definition: Number of hospital discharges among children ages 0-17, excluding newborns, by payer expected to cover the greatest share of expenses for treatment (e.g., in 2020, Medi-Cal was the expected source of payment for 87,100 hospitalizations among California children).Percentage of hospital discharges among children ages 0-17, excluding newborns, by payer expected to cover the greatest share of expenses for treatment (e.g., in 2020, Medi-Cal was the expected source of payment for 50.7% of hospitalizations among California children).
- Data Source: California Dept. of Health Care Access and Information custom tabulation (Feb. 2021).
- Footnote: Data are based on the number of hospitalizations, not the number of children hospitalized. Data are limited to hospital admissions; emergency department visits that do not result in admission are excluded. Detailed descriptions of payment sources are available from the Dept. of Health Care Access and Information. County-level data reflect the patient's county of residence, not the county in which the hospitalization occurred. Cases with unknown county of residence are included in California totals. Data are excluded for cases of patients with erroneous birth dates and for erroneous, unknown, or unreported sources of payment. The notation S refers to numbers and percentages that have been suppressed because there were, depending on the year, fewer than 5 (2013 and earlier) or fewer than 20 (2014 and later) hospitalizations with that expected source of payment, and to percentages that have been suppressed because the value was less than 0.1%. Changes to admissions coding in 2017 could introduce variation in the exclusion of newborn cases; for more information, see the California Inpatient Data Reporting Manual.
Learn More About Hospital Use
- Measures of Hospital Use on Kidsdata.org
Kidsdata.org provides the following measures of hospital use among children ages 0-17:
Indicators of hospital use on kidsdata.org exclude visits for childbirth.
- Emergency department (ED) visits, in which a patient is treated and released without being admitted to the hospital. The number of ED visits overall, the number and percentage of visits for the most common primary diagnoses, and the number and percentage of visits by expected source of payment are available for the state, counties, and county groups.
- Hospital discharges, which reflect stays that generally involve a longer course of treatment for which a patient is admitted to the hospital. As with ED visits, data are presented for hospital discharges overall, the most common primary diagnoses for hospital stays, and expected sources of payment for hospitalization expenses.
- Hospital Use
- Characteristics of Children with Special Needs
- Access to Services for Children with Special Needs
- Child Abuse and Neglect
- Emergency Department Visits for Child Abuse and Neglect (California Only)
- Hospital Discharges for Child Abuse and Neglect (California Only)
- Children's Emotional Health
- Health Insurance Coverage for Children with Special Health Care Needs
- Health Insurance Coverage for Children with Special Health Care Needs, by Type of Insurance (California & U.S. Only)
- Adequacy of Health Insurance Coverage, by Special Needs Status (California & U.S. Only)
- Consistency of Health Insurance Coverage, by Special Needs Status (California & U.S. Only)
- Impacts of Special Health Care Needs on Children and Families
- Health Care
- Health Insurance Coverage, by Type and Age Group
- Health Insurance Coverage Status, by Race/Ethnicity
- Medicaid (Medi-Cal) or Children's Health Insurance Program (CHIP) Coverage
- Medicaid (Medi-Cal) or CHIP Coverage, by Age Group (California & U.S. Only)
- Medicaid (Medi-Cal) and CHIP Yearly Enrollment (California & U.S. Only)
- Medi-Cal Average Monthly Enrollment
- Uninsured at Any Point in Past Year
- Usual Source of Health Care
- Youth Suicide and Self-Inflicted Injury
- Why This Topic Is Important
All children should have high-quality, accessible, affordable health care, including hospital care when needed. Children with special health care needs, in particular, may require more frequent hospital visits and specialized, intensive medical services. Ensuring that all children have consistent access to affordable, evidence-based, well coordinated, comprehensive, and family-centered care—all within the context of a medical home—can maximize positive outcomes (1). This type of care also may reduce costly hospitalizations and emergency department visits (1).
While emergency departments (EDs) are critical sources of acute care for children, frequent or non-urgent ED visits may be an indication of unmet health needs or difficulty accessing appropriate pediatric care (2). Children from vulnerable groups, especially young children ages 0-5 and those from low-income households, tend to have disproportionately high rates of ED use (3).
Data on hospital use can illuminate trends in health and health care needs, and can inform disease surveillance and public health prevention efforts. For example, data show that ED visits for psychiatric issues have been rising among young people nationwide, with teens and youth of color experiencing the largest increases (4). Additionally, mental illness has become the most common cause of hospitalization among children in California and the U.S. (5, 6). Children admitted to the hospital for mental health reasons also are more likely to have unplanned readmissions than children with other diagnoses (5). These data point to urgent mental health care needs among youth nationwide.For more information, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. National Academies of Sciences, Engineering, and Medicine. (2018). Opportunities for improving programs and services for children with disabilities. National Academies Press. Retrieved from: https://nap.nationalacademies.org/catalog/25028/opportunities-for-improving-programs-and-services-for-children-with-disabilities
2. Taylor, T., & Salyakina, D. (2019). Health care access barriers bring children to emergency rooms more frequently: A representative survey. Population Health Management, 22(3), 262-271. Retrieved from: https://www.liebertpub.com/doi/10.1089/pop.2018.0089
3. McDermott, K. W., et al. (2018). Overview of pediatric emergency department visits, 2015. Agency for Healthcare Research and Quality. Retrieved from: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb242-Pediatric-ED-Visits-2015.jsp
4. Kalb, L. G., et al. (2019). Trends in psychiatric emergency department visits among youth and young adults in the U.S. Pediatrics, 143(4), e20182192. Retrieved from: https://publications.aap.org/pediatrics/article/143/4/e20182192/76774/Trends-in-Psychiatric-Emergency-Department-Visits
5. Feng, J. Y., et al. (2017). Readmission after pediatric mental health admissions. Pediatrics, 140(6), e20171571. Retrieved from: https://publications.aap.org/pediatrics/article/140/6/e20171571/38254/Readmission-After-Pediatric-Mental-Health
6. As cited on kidsdata.org, Hospital discharges, by primary diagnosis. (2022). California Department of Health Care Access and Information.
- How Children Are Faring
In 2020, the first year of the COVID-19 pandemic, California children ages 0-17 made almost 1.2 million fewer visits to emergency departments (EDs) than in 2019—a drop of 43%. Traumatic injuries are the most common primary diagnosis among children visiting the ED, representing more than 12% of visits statewide in 2020, followed by viral illnesses or fevers of unknown origin (8%) and fractures (4%). As in previous years, Medi-Cal was the payment source for almost two thirds (63%) of childhood ED visits in 2020, compared with private insurance at 29%. At the local level, payment sources for ED visits vary widely; e.g., the share of visits covered by Medi-Cal in 2020 ranged from 33% to 80% across counties and county groups.
In 2020, there were 171,769 hospital discharges among California children, a 22% decrease from 2019. More than one in six (17%) of those hospital stays were for a primary diagnosis of mental disease or disorder, followed by asthma/bronchitis (5%) and seizures/headaches (4%). Although mental illness has been the most common cause of childhood hospitalization statewide since 2008, wide variation exists across regions. For instance, in 2020, the share of discharges for mental diseases and disorders was higher than 25% for Placer and Sonoma counties and lower than 10% for Butte, Imperial, and Santa Barbara counties. Among California children discharged in 2020, Medi-Cal covered the hospitalization expenses for more than half (51%) of those stays, compared with private insurance at 37%. Since 2002, the percentage of hospitalizations covered by private insurers has generally decreased, while the percentage covered by Medi-Cal has increased.
- Policy Implications
Hospital care for children is changing. While hospital admissions have been declining, readmissions appear to be rising due to increasing numbers of children with chronic health conditions (1). Admissions, readmissions, and emergency department (ED) visits may be reduced through effective care coordination and discharge planning, especially for children with special health care needs (2, 3). Hospital utilization data can reveal the conditions and populations for which targeted care management and preventive services could have the greatest impact.
Emergency care for children also has unique challenges. Most children who need emergency care visit community hospital EDs (rather than those at children's hospitals), which may not be well equipped to care for children with special health care needs, or for pediatric care in general (2, 4). Many EDs face overcrowding, too, as they often function as a safety net for those with unmet health needs or limited access to care (5, 6). Low-income children are more likely to use EDs than higher-income children, and research shows that improving access to appropriate pediatric care may reduce unnecessary ED visits (5, 7).
Policy and practice options that could reduce preventable hospital use and improve pediatric care before, during, and after hospitalizations and ED visits include:
For more policy ideas and research on this topic, visit kidsdata.org’s Research & Links section. Also see Policy Implications under Health Care, Children's Emotional Health, Asthma, and topics related to Children with Special Health Care Needs.
- Reducing care fragmentation and inefficiency within and across health systems by establishing care coordination services within a patient- and family-centered medical home, including a team-based, strengths-based, comprehensive approach to meeting children's needs while enhancing the caregiving capabilities of families (2, 8)
- Ensuring that all children have high-quality, accessible, and affordable health care to promote prevention and effective management of chronic conditions (2, 8)
- Reducing obstacles that can prevent families from obtaining timely and appropriate care, such as linguistic or cultural barriers, difficulties finding a doctor or making an appointment, and transportation issues; also, improving family health literacy regarding primary care availability and appropriate use of EDs (5)
- Promoting efforts to improve pediatric readiness in all EDs, in accordance with American Academy of Pediatrics guidelines, including identification of a physician and nurse pediatric coordinator, and an ongoing commitment that all aspects of EDs, from policies and staff competencies to equipment and medications, are set up to meet the specific needs of children (4)
- Implementing a standardized, pediatric-specific framework for the transition from hospital to home care that begins at the time of admission, involves the entire care team, engages the child's family, considers family circumstances and social determinants of health, provides clear documentation, and follows up with the family after discharge (3, 9)
- Continuing to promote community-wide, integrated interventions to decrease the burden of asthma on populations facing increased risk, such as low-income families and children of color, including strategies to improve insurance coverage among the uninsured and under-insured, provide home visiting and education, and reduce environmental asthma triggers (10)
- Adopting a comprehensive, evidence-based approach to mental health services for youth that expands and improves prevention, screening, and access to services, while also promoting positive mental health and providing access to wellness supports for all children and families (11)
- Continuing to support research on strategies to reduce preventable hospital use, particularly for children with special health care needs (1)
Sources for this narrative:
1. Bucholz, E. M., et al. (2019). Trends in pediatric hospitalizations and readmissions: 2010-2016. Pediatrics, 143(2), e20181958. Retrieved from: https://publications.aap.org/pediatrics/article/143/2/e20181958/37344/Trends-in-Pediatric-Hospitalizations-and
2. National Academies of Sciences, Engineering, and Medicine. (2018). Opportunities for improving programs and services for children with disabilities. National Academies Press. Retrieved from: https://nap.nationalacademies.org/catalog/25028/opportunities-for-improving-programs-and-services-for-children-with-disabilities
3. Lax, Y., et al. (2017). Social determinants of health and hospital readmission. Pediatrics, 140(5), e20171427. Retrieved from: https://publications.aap.org/pediatrics/article/140/5/e20171427/37757/Social-Determinants-of-Health-and-Hospital
4. Remick, K., et al. (2018). Pediatric readiness in the emergency department. Pediatrics, 142(5), e20182459. Retrieved from: https://publications.aap.org/pediatrics/article/142/5/e20182459/38608/Pediatric-Readiness-in-the-Emergency-Department
5. Taylor, T., & Salyakina, D. (2019). Health care access barriers bring children to emergency rooms more frequently: A representative survey. Population Health Management, 22(3), 262-271. Retrieved from: https://www.liebertpub.com/doi/10.1089/pop.2018.0089
6. Kalb, L. G., et al. (2019). Trends in psychiatric emergency department visits among youth and young adults in the U.S. Pediatrics, 143(4), e20182192. Retrieved from: https://publications.aap.org/pediatrics/article/143/4/e20182192/76774/Trends-in-Psychiatric-Emergency-Department-Visits
7. McDermott, K. W., et al. (2018). Overview of pediatric emergency department visits, 2015. Agency for Healthcare Research and Quality. Retrieved from: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb242-Pediatric-ED-Visits-2015.jsp
8. American Academy of Pediatrics, Council on Children with Disabilities & Medical Home Implementation Project Advisory Committee. (2018). Patient- and family-centered care coordination: A framework for integrating care for children and youth across multiple systems. Pediatrics, 133(5), e1451-e1460. Retrieved from: https://publications.aap.org/pediatrics/article/133/5/e1451/32796/
9. Berry, J. G., et al. (2014). A framework of pediatric hospital discharge care informed by legislation, research, and practice. JAMA Pediatrics, 168(10), 955-966. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603147
10. California Department of Public Health. (2015). Strategic plan for asthma in California: 2015-2019. Retrieved from: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/EHIB/CPE/CDPH Document Library/SPAC2014_7-28-15APR.pdf
11. National Academies of Sciences, Engineering, and Medicine. (2019). Fostering healthy mental, emotional, and behavioral development in children and youth: A national agenda. National Academies Press. Retrieved from: https://nap.nationalacademies.org/catalog/25201/fostering-healthy-mental-emotional-and-behavioral-development-in-children-and-youth
- Research & Links
- Websites with Related Information
- Asthma in Children and Adolescents: Professional Resource Guide. Maternal and Child Health Digital Library.
- California Dept. of Health Care Services
- Children's Hospital Association
- Children's Mental Health. Centers for Disease Control and Prevention.
- National Institute of Mental Health: Child and Adolescent Mental Health
- National Pediatric Readiness Project. Emergency Medical Services for Children Innovation and Improvement Center.
- National Resource Center for Patient/Family-Centered Medical Home. American Academy of Pediatrics.
- Key Reports and Research
- Children’s Mental Health Emergency Department Visits: 2007–2016. (2020). Pediatrics. Lo, C. B., et al.
- Costs of Pediatric Hospital Stays, 2016. (2019). Healthcare Cost and Utilization Project. Moore, B. J., et al.
- Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5-24 Years, 2010-2016. (2019). National Health Statistics Reports. Rui, P., et al.
- Health Care Access Barriers Bring Children to Emergency Rooms More Frequently: A Representative Survey. (2019). Population Health Management. Taylor, T., & Salyakina, D.
- Hospitalization for Suicide Ideation or Attempt: 2008–2015. (2018). Pediatrics. Plemmons, G., et al.
- Opportunities for Improving Programs and Services for Children with Disabilities. (2018). National Academies Press. National Academies of Sciences, Engineering, and Medicine.
- Overview of Pediatric Emergency Department Visits, 2015. (2018). Healthcare Cost and Utilization Project. McDermott, K. W., et al.
- Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems. (2018). Pediatrics. American Academy of Pediatrics, Council on Children with Disabilities & Medical Home Implementation Project Advisory Committee.
- Pediatric Readiness in the Emergency Department. (2018). Pediatrics. Remick, K., et al.
- Social Determinants of Health and Hospital Readmission. (2017). Pediatrics. Lax, Y., et al.
- Statewide Child Abuse and Neglect Non-Fatal Injury Trends Observed in California Hospitals and Emergency Departments During the COVID-19 Pandemic. (2022). California Essentials for Childhood Initiative.
- County/Regional Reports
- Important Facts About Kern’s Children. Kern County Network for Children.
- Live Well San Diego Report Card on Children, Families, and Community. The Children’s Initiative.
- Santa Clara County Children's Data Book. Santa Clara County Office of Education, et al.
- Santa Clara County Public Health Department: Open Data Portal
- More Data Sources For Hospital Use
- Ambulatory Health Care Data. National Center for Health Statistics.
- Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality.
- National Survey of Children's Health. Child and Adolescent Health Measurement Initiative.
- Office of Statewide Health Planning and Development: Data and Reports
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