Written by Kimiko Dunbar
Spoon Feed
While pediatric bed capacity is equal across areas with high or low social determinants of health, there are differences in resource availability; hospitals that serve underprivileged or rural communities have lower expenditures/bed and higher staff/patient ratios.
Not all beds are created equal
This study examined pediatric inpatient bed capacity and hospital resources by social determinants of health (SDoH) using a cross-sectional analysis of 1,118,502 discharges across 1,404 U.S. hospitals. Authors found that while overall bed capacity was evenly distributed (3.26 beds/10,000 children, 95%CI 3.24-3.29), hospitals serving underprivileged, rural, and minority communities had lower per-bed expenditures, staff, and transfer capability. Hospitals that serve White or Asian children spent more money per bed and had more staff than those serving Hispanic/Latino or Black children (a difference of over 70,000 less spent per bed). Further, these hospitals had higher rates of Medicaid reimbursement, which likely contributes to lack of resources, given Medicaid’s relatively low reimbursement rate. As a measure of quality/risk, authors assessed each hospital’s risk-adjusted CLABSI rate and found no differences in rate of central line infection. This study uses a market share approach to assess costs and allocation of resources – a highly theoretical approach which relies on a number of assumptions. Furthermore, this study relies on administrative data. Findings highlight disparities in pediatric hospital resources despite comparable bed distribution.
How will this change my practice?
This study highlights disparities in pediatric beds across the country. While a pediatric bed may be available regardless of where one lives, the quality and resources of that bed seem to vary quite a bit based on who will be occupying it. It’s hard to know exactly how cost per bed translates to patient care – not all costs are reflective of high-value care. Overall, this study doesn’t change much in my personal practice but does make me much more informed from an advocacy perspective. Increasing beds in underserved areas seems to be much less important than ensuring quality and availability of resources for the beds available.
Source
Access to Pediatric Bed Capacity According to Social Determinants of Health: All Beds Are Not Created Equal. J Pediatr. 2025 Mar;278:114447. doi: 10.1016/j.jpeds.2024.114447. Epub 2024 Dec 21. PMID: 39716543
