Pediatric Critical Care: Regional Hospitals Close Units as Costs Rise

Families in rural and suburban communities are facing longer travel times for emergency pediatric care as hospitals across the United States close units dedicated to the country's sickest children. In the past year, facilities in Montana, Oregon, and Missouri discontinued services for critically ill kids, while overnight pediatric wings in Illinois and California also closed.

These units, which serve patients from infancy through early adulthood, are distinct from neonatal intensive care. As hospitals seek to reduce operating costs, many have converted these beds to serve newborns or adults. This shift has centralized critical care in major medical hubs, requiring patients to travel greater distances for treatment.

Elizabeth Mack, a pediatric critical care doctor and spokesperson for the American Academy of Pediatrics, stated that expecting patients to remain stable when the nearest children's hospital is a flight away or an eight-hour drive is unrealistic. She described the decision to cut services as a financial calculation, noting that the field is not sustainable without additional support.

Hospital administrators frequently cite low patient volumes as a primary factor. Pediatric intensive care is rare, and the nation faces a shortage of subspecialists who typically earn less than their adult-focused counterparts. Hospitals also receive lower reimbursement rates for treating children compared to adults, and specialized equipment incurs additional costs.

A recent analysis found that pediatric inpatient units declined by nearly 30% between 2008 and 2022. The number of hospitals offering these services dropped from 1,749 to 1,226, leaving three-quarters of facilities without any pediatric inpatient capability. Researchers warn that gaps in care will widen as federal Medicaid spending faces administrative hurdles and stricter eligibility requirements, affecting about half of the nation's children.

Greg Cook, CEO of Community Medical Center in Missoula, said the hospital can still treat most children but will now stabilize the most critical cases before transferring them. The unit's closure impacts roughly 25 patients annually. The next closest pediatric intensive care unit is in Kalispell, approximately 150 miles north. Cook noted that the hospital has been unable to recruit local critical care doctors since the last specialist retired eight years ago, averaging only two intensive care cases per month prior to the closure.

Kenneth Michelson, lead author of the study on declining units, said the reduction in critical care capacity ripples into routine services. The number of hospitals performing pediatric appendectomies decreased by more than half from 2003 to 2022. He characterized critical care as a national necessity rather than a standard commodity, emphasizing that children's lives depend on timely access.