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OBJECTIVE Comparison of the actual cost of hospitalization in a pediatric intensive care unit (ICU) and in an adult ICU with the reimbursement paid by the National Organization for the Provision of Health Services (EOPYY) to each hospital for ICU expenses. METHOD A retrospective observational study was carried out. The actual cost was estimated using the bottom-up cost analysis methodology. The hospital compensation from the EOPYY was calculated, taking into account the length of hospitalization of the patients. Sociodemographic and clinical characteristics were retrieved from the patients' files. The financial daily deficit per ICU bed was calculated as the difference between the actual cost of hospitalization and EOPYY hospital compensation, in order to evaluate the hospital expense. The actual cost of hospitalization and the hospital compensation from EOPYY were estimated for the patients admitted to one adult ICU and one pediatric ICU in hospitals located in Attica, Greece, for four calendar years (January 2016-December 2019). RESULTS A total number of 928 pediatric and 718 adult ICU patients were admitted during the study period and their expenses constitute the basis of this study. The actual hospital ICU costs were higher than the amount compensated by EOPYY, for both the adult and the pediatric ICU population. The financial daily deficit per ICU bed was remarkably higher in the pediatric ICU. The most significant contributor to the actual cost of ICU care was personnel reimbursement. CONCLUSIONS The introduction in Greece of the diagnosis-related system for estimation of care costs (KEN-DRGs) does not appear to provide adequate compensation for public hospitals regarding hospitalization of patients in the ICU. [ABSTRACT FROM AUTHOR]