Decrease of Peds units

With the ever increasing proportion of pediatrics having medicaid over private insurance most pediatric units hemorrhage money.

Larger hospitals can typically make this up with large PICU, NICU, and surgery programs but smaller community units can't stay out of the red with relatively low acuity medical cases.

Add to that the fact that so many large children's hospitals are now being ran like businesses regardless of their purported non-profit status and they are largely trying to steamroll community pediatrics out of the region.

I don't think that cases that are borderline are necessarily being sent home rather than admitted, but the advent of stronger evidence between treatment regimes largely supports outpatient treatment with close primary care followup where before we didn't have as good of an understanding of the progression of illness.

I don't think it is a matter of community hospitals not 'wanting' pediatrics, but the financial reality makes it very difficult at best.

At the risk of getting a bit political this is a big risk with underfunded government programs. This is spread across many centers from county hospitals, critical access, general community hospitals, and even large academic formerly mixed population hospitals. The only systems increasing their pediatrics are the large regional children's hospitals, who use it as a gateway to their specialty programs that actually make money.