736 - Association Between Hospital Ownership and Percentage of Medicaid Cleft Lip/Palate Discharges

Access to cleft lip and palate surgical care is critical for timely treatment and prevention of cosmetic and functional disabilities associated with this common congenital anomaly. Financial and geographic constraints can impact access to multidisciplinary care programs in the US.

Objective:

We sought to examine the association between proportion of Medicaid beneficiaries among cleft lip/palate repair discharges in US hospitals and hospital characteristics.

Design/Methods:

Using the Kids’ Inpatient Database (KID) from 2006, we identified hospital characteristics of cleft lip/palate repair discharges as classified by KID including: hospital bed size (small, medium, large), teaching status (teaching, non-teaching), location (urban teaching, urban non-teaching, rural), and control/ownership of hospital (government or private – collapsed category, government/nonfederal/public, private – collapsed category, private – invest-own, private – non-profit/voluntary). We also identified the percentage of Medicaid beneficiaries among cleft lip/palate discharges for each hospital. Univariate logistic regression model was used to examine one-to-one association between hospital characteristics and percentage of Medicaid discharges. Characteristics with p value < 0.25 entered multiple logistic regression model. Adjusted odds ratios with 95% confidence intervals were reported.

Results:

We identified 4,508 discharges with a mean age at admission of 2.9 years (range 0 to 20 years; 2,507 males, 1,860 females, 141 missing gender), who had undergone cleft lip and/or palate repair surgery. Of these, 1921 (42.42%) had Medicaid as their primary payer, and these discharges were from 300 hospitals in the US. The median percentage of Medicaid beneficiaries among a hospital’s cleft lip/palate discharges was 40% (range 0% to 100%). After adjusting for bed size and teaching status, control/ownership of hospital was statistically significantly associated with having Medicaid discharges (p=0.0145). The odds of having Medicaid discharges among private, invest-own hospitals was 0.38 [0.18, 0.83] times that of government or private – collapsed category hospitals (p=0.0156). Bed size and teaching status of the hospital were not associated with having Medicaid discharges.

Conclusion(s): Private, invest-own hospitals are less likely to serve patients with cleft lip/palate who have Medicaid as their primary payer compared to government or private collapsed category hospitals. These results may not accurately reflect current data due to Medicaid expansion. Future research may focus on whether this trend is associated with health disparities.