Who pays the most for neonatal intensive care? An analysis of the out-of-pocket cost burden borne by NICU families.

OBJECTIVE: To document direct medical out-of-pocket (OOP) cost of NICU admissions and investigate structural contributions to differential cost burden. STUDY DESIGN: Survey-weighted multivariable regression analyzed the relationship between OOP cost and structural covariates, in a cross-sectional study of 813 NICU patients with admissions reported in the 2000-2021 U.S. Medical Expenditures Panel Survey. RESULTS: The OOP cost distribution was right-skewed with median = $0, IQR = $181, and range = $0-$58 584. Relative to a publicly-insured, lowest-income ( < 100% of FPL) reference group, covariates for insurance type and income bracket were significant to ≥95% confidence: costs were 11x higher for the privately-insured, 15x higher for the uninsured, and 1.4x higher per income bracket increase. Predicted mean costs for families with incomes <100% of FPL are: Public Only Insurance: $126; Any Private Insurance: $1382; Uninsured: $1916. CONCLUSION: While NICU OOP costs appear lower among the publicly-insured, substantial costs burden privately-insured and uninsured families.