children, end of life care, hospice care, pediatric, transaction cost analysis



  1. Lindley, Lisa C. PhD, RN


With the passage of the Patient Protection and Affordable Care Act of 2010, hospice care for children changed. The change in the hospice eligibility rule for children is expected to increase hospice utilization, and hospices will now be faced with acquiring pediatric hospice care knowledge either internally or externally. This article sought to predict, using transaction cost analysis, which hospices will acquire pediatric knowledge internally (insourcing) compared with purchasing knowledge through the external market (outsourcing). A set of propositions was developed about how transaction characteristics (ie, frequency, asset specificity, uncertainty) may affect the internal or external acquisition of pediatric hospice care knowledge. The analysis revealed that there is a greater probability of hospices acquiring internal pediatric hospice care knowledge in an environment of high frequency, high asset specificity, and high uncertainty. This study has implication for hospice and palliative care nurses.