# Determinants of hospitalization expenditure for pediatric congenital heart disease: a single-center study from Xinjiang, China

## TL;DR

This study identifies factors affecting hospital costs for children with heart defects in Xinjiang, China, to help reduce financial burdens and improve insurance policies.

## Contribution

The study provides new insights into cost determinants for pediatric congenital heart disease in a specific Chinese region.

## Key findings

- Hospitalization costs for open-heart surgery were higher than interventional procedures.
- Factors like age under 2 years and lack of health insurance were linked to higher costs.
- Health insurance indirectly reduced costs by shortening hospital stays.

## Abstract

This study aimed to identify key determinants of hospitalization costs for children aged 0–14 years with congenital heart disease (CHD) at a tertiary hospital in Xinjiang, China, to provide evidence for reducing the financial burden on families and improving health insurance policies.

We conducted a retrospective analysis of medical records from 2,811 pediatric patients who underwent CHD surgery between September 2013 and September 2024. Potential influencing factors were screened using non-parametric tests, and mediating effects were examined through the Bias-Corrected Bootstrap method with 5,000 repetitions. Path analysis modeling was performed with AMOS 24.0 to clarify direct and indirect pathways among variables affecting hospitalization costs.

Median hospitalization costs for CHD patients showed an initial increase followed by a progressive decline, with sustained reduction after 2019. Costs for open-heart surgery consistently exceeded those for interventional procedures, with the former dominated by treatment fees and the latter primarily composed of material costs. Several factors were significantly associated with higher costs, including age under 2 years, absence of health insurance, complex CHD, open-heart surgery, and hospital stays lasting 20 days or longer (all P < 0.05). Path analysis indicated that older age (β = −0.047) indirectly reduced costs through the “treatment approach → length of stay” pathway. In contrast, both disease type (β = 0.087) and severity (β = 0.061) demonstrated positive indirect effects along the same pathway. Health insurance (β = −0.045) contributed to cost reduction indirectly through its association with shorter hospitalization.

Multiple clinical and socioeconomic factors influence hospitalization costs for children with CHD. To minimize the risk of catastrophic health expenditures for families, we recommend prioritizing interventional procedures, optimizing insurance reimbursement strategies, and enhancing awareness and enrollment in neonatal health insurance programs.