Автор |
Arndt, Margarete |
Автор |
Bradbury, Robert, C. |
Автор |
Golec, Joseph, H. |
Автор |
M. Steen, Paul |
Дата выпуска |
1998 |
dc.description |
This study of 45,691 patients from 73 hospitals in 22 states shows that Medicaid patients have longer total lengths of stay as well as longer preoperative and postoperative lengths of stay than privately insured patients after adjusting for admission severity of illness and other patient variables. Medicaid patients also had higher ancillary charges and higher total charges. These hospital utilization patterns held in states that paid hospitals per case as well as in states that paid hospitals per diem rates with the exception of ancillary services in the per diem states. A direct test between Medicaid patients under the two payment systems revealed no difference in length of stay, ancillary, and total charges. These findings suggest that service levels to Medicaid patients were not associated with how the hospitals were paid and challenge the assumptions that hospitals can continue to reduce services in response to reimbursement constraints. The implications of these findings for health policy and health services management are discussed. |
Издатель |
Sage Publications |
Название |
A Comparison of Hospital Utilization by Medicaid and Privately Insured Patients |
Тип |
Journal Article |
DOI |
10.1177/107755879805500102 |
Print ISSN |
1077-5587 |
Журнал |
Medical Care Research and Review |
Том |
55 |
Первая страница |
32 |
Последняя страница |
53 |
Аффилиация |
Arndt, Margarete, Clark University |
Аффилиация |
Bradbury, Robert, C., Clark University |
Аффилиация |
Golec, Joseph, H., Clark University |
Аффилиация |
M. Steen, Paul, Mediqual Systems, Inc. |
Выпуск |
1 |
Библиографическая ссылка |
Aday, L. A., and S. M. Shortell. 1988. Indicators and Predictors of Health Services Utilization. In Introduction to Health Services, edited by S. J. Williams and P. R. Torrens. New York: John Wiley. |
Библиографическая ссылка |
Arndt, M., and B. Bigelow. 1994. The Impact of Individual and Contextual Factors on Nursing Care and the Implementation of ACHPR Practice Guidelines. Medical Care Review51 (1):61-82. |
Библиографическая ссылка |
Arndt, M., and R. C. Bradbury. 1995. Admission Severity of Illness and Resource Utilization: Comparing Medicaid and Privately Insured Patients. Hospital & Health Services Administration40 (2):210-226. |
Библиографическая ссылка |
Ayanian, J. Z., B. A. Kohler, T. Abe, and A. M. Epstein. 1993. The Relation between Health Insurance Coverage and Clinical Outcomes among Women with Breast Cancer. New England Journal of Medicine329 (5):326-331. |
Библиографическая ссылка |
Blendon, R. J., K. Donelan, C. Hill, A. Scheck, W. Carter, D. Beatrice, and D. Altman. 1993. Medicaid Beneficiaries and Health Reform. Health Affairs, spring, 132-143. |
Библиографическая ссылка |
Bradbury, R. C., J. H. Golec, and F. E. Stearns. 1991. Comparing Hospital Length of Stay in Independent Practice Associations, HMOs, and Traditional Insurance Programs. Inquiry28 (1):52-58. |
Библиографическая ссылка |
Braveman, P., S. Egerter, V. M. Schaaf, T. Bennett, and W. Schecter. 1994. Insurance-Related Differences in the Risk of Ruptured Appendix. New England Journal of Medicine331 (7):444-449. |
Библиографическая ссылка |
Brody, B., N. Wray, S. Bame, C. Ashton, N. Peterson, and M. Harward. 1991. The Impact of Economic Considerations on Clinical Decision making: The Case of Thrombolytic Therapy. Medical Care29 (9):899-910. |
Библиографическая ссылка |
Burns, L. R., D. R. Wholey, and M. O. Abeln. 1993. Hospital Utilization and Mortality Levels for Patients in the Arizona Health Care Cost Containment System. Inquiry30 (2):142-156. |
Библиографическая ссылка |
Corporate Cost Management. 1989. Hospital Charge Adjustment Methodology: Documentation. Gaithersburg, MD: Corporate Cost Management, Inc. |
Библиографическая ссылка |
Cromwell, J., K. W. Adamache, C. Ammering, W. J. Bartosch, and A. Boulis. 1995. Equity of the Medicaid Program to the Poor Versus Taxpayers. Health Care Financing Review16 (3):75-104. |
Библиографическая ссылка |
DesHarnais, S., E. Kobrinsky, J. Chesney, M. Long, R. Ament, and S. Fleming. 1987. The Early Effects of the Prospective Payment System on Inpatient Utilization and the Quality of Care. Inquiry24 (1):7-16. |
Библиографическая ссылка |
Duffy, S. Q., and D. E. Farley. 1995. Patterns of Decline among Inpatient Procedures. Public Health Report110 (6):674-681. |
Библиографическая ссылка |
Dutton, D. B.1986. Social Class, Health, and Illness. In Applications of Social Science to Clinical Medicine and Health Policy (pp. 31-62), edited by L. H. Aiken and D. Mechanic. New Brunswick, NJ: Rutgers University Press. |
Библиографическая ссылка |
Eisenberg, J. M.1986. Doctors' Decisions and the Cost of Medical Care. Ann Arbor, MI: Health Administration Press. |
Библиографическая ссылка |
Epstein, A. M., R. S. Stern, and J. S. Weissman. 1990. Do the Poor Cost More? A Multihospital Study of Patients' Socioeconomic Status and Use of Hospital Resources. New England Journal of Medicine322 (16):1122-1128. |
Библиографическая ссылка |
Fossett, J. W.1993. Medicaid and Health Reform: The Case of New York. Health Affairs, fall, 81-94. |
Библиографическая ссылка |
Frank, R. G., and J. R. Lave. 1989. A Comparison of Hospital Responses to Reimbursement Policies for Medicaid Psychiatric Patients. RAND Journal of Economics20 (4):588-600. |
Библиографическая ссылка |
Freund, P.E.S., and McGuire, M.1991. Health, Illness, and the Social Body. Englewood Cliffs, NJ: Prentice Hall. |
Библиографическая ссылка |
Gold, M., L. Nelson, T. Lake, R. Hurley, and R. Berenson. 1995. Behind the Curve: A Critical Assessment of How Little Is Known about Arrangements between Managed Care Plans and Physicians. Medical Care52 (3):307-341. |
Библиографическая ссылка |
Guterman, S., P. W. Eggers, G. Riley, T. F. Greene, and S. A. Terrell. 1988. The First Three Years of Medicare Prospective Payment: An Overview. Health Care Financing Review9 (3):67-77. |
Библиографическая ссылка |
Haas, J. S., and L. Goldman. 1994. Acutely Injured Patients with Trauma in Massachusetts: Differences in Care and Mortality, by Insurance Status. American Journal of Public Health84 (10):1605-1608. |
Библиографическая ссылка |
Hillman, B. J., G. T. Olson, P. E. Griffith, J. H. Sunshine, C. A. Joseph, S. D. Kennedy, W. R. Nelson, and L. B. Bernhardt. 1992. Physician's Utilization and Charges for Outpatient Diagnostic Imaging in a Medicare Population. Journal of the American Medical Association268 (15):2050-2054. |
Библиографическая ссылка |
Hinshaw, A. S., J. Verran, and H. Chance. 1977. A Description of Nursing Care Requirements in Six Hospitals. Communicating Nursing Research9:261-283. |
Библиографическая ссылка |
Horner, R. D., C. L. Bennett, D. Rodriguez, R. A. Weinstein, H. A. Kessler, G. M. Dickinson, J. L. Johnson, S. E. Cohn, W. L. George, and S. C. Gilman. 1995. Relationship between Procedures and Health Insurance for Critically Ill Patients with Pneumocystis carinii pneumonia. American Journal of Respiratory Critical Care Medicine, November, 1435-1442. |
Библиографическая ссылка |
Iezzoni, L. I.1993. Monitoring Quality of Care: What Do We Need to Know?Inquiry30 (summer):112-114. |
Библиографическая ссылка |
Iezzoni, L. I., ed. 1994. Risk Adjustment for Measuring Health Care Outcomes. Ann Arbor, MI: Health Administration Press. |
Библиографическая ссылка |
Iezzoni, L. I., A. S. Ash, J. L. Cobb, and M. A. Moskowitz. 1988. Admission Medis-Groups Score and the Cost of Hospitalization. Medical Care26 (11):1068-1080. |
Библиографическая ссылка |
Iezzoni, L. I., A. S. Ash, G. A. Coffman, and M. A. Moskowitz. 1992. Predicting In-Hospital Mortality: A Comparison of Severity Measurement Approaches. Medical Care30 (April):347-359. |
Библиографическая ссылка |
Kane, N. M., and P. Manoukian. 1989. The Effect of the Medicare Prospective Payment System on the Adoption of New Technology. New England Journal of Medicine321 (20):1378-1383. |
Библиографическая ссылка |
Kerr, E. A., and A. L. Siu. 1993. Follow-up after Hospital Discharge: Does Insurance Make a Difference?Journal of Health Care for the Poor and Underserved4 (2):133-142. |
Библиографическая ссылка |
Kuykendall, D. H., M. L. Johnson, and J. M. Geraci. 1995. Expected Source of Payment and Use of Hospital Services for Coronary Atherosclerosis. Medical Care33 (7):715-728. |
Библиографическая ссылка |
Lambert, C. A., D. R. Netherton, L. J. Finison, J. N. Hyde, and S. J. Spaight. 1982. Risk Factors and Life Style: A Statewide Health-Interview Survey. New England Journal of Medicine306 (17):1048-1051. |
Библиографическая ссылка |
Langa, K. M., and E. J. Sussman. 1993. The Effect of Cost-Containment Policies on Rates of Coronary Revascularization in California. New England Journal of Medicine329 (24):1784-1789. |
Библиографическая ссылка |
Latest Medicaid Reform Plans Would Jeopardize Health of Poor. 1996. The Nation's Health, March, 1, 4. |
Библиографическая ссылка |
Lave, J. R., and R. G. Frank. 1990. Effect of the Structure of Hospital Payment on Length of Stay. Health Services Research25 (2):327-347. |
Библиографическая ссылка |
Marmot, M. G., M. Kogevinas, and M. A. Elston. 1987. Social/Economic Status and Disease. Annual Review of Public Health8:111-135. |
Библиографическая ссылка |
Melnick, G. A., J.R.C. Wheeler, and P. J. Feldstein. 1981. Effects of Rate Regulation on Selected Components of Hospital Expenses. Inquiry18 (3):240-246. |
Библиографическая ссылка |
Preston, B. J., M. M. Ruther, D. Baugh, and R. McDevitt. 1992. Outcomes of California's Medicaid Cost-Containment Policies, 1981-84. Health Care Financing Review14 (1):65-78. |
Библиографическая ссылка |
Riessman, C. K.1983. Women and Medicalization. Social Policy14:3-18. |
Библиографическая ссылка |
Rotwein, S., M. Boulmetis, P. J. Boben, H. I. Fingold, J. P. Hadley, K. L. Rama, and D. Van Hoven. 1995. Medicaid and State Health Care Reforms: Process, Programs, and Policy Options. Health Care Financing Review16 (3):105-120. |
Библиографическая ссылка |
Shortell, S. M., and J. P. LoGerfo. 1981. Hospital Medical Staff Organization and Quality of Care. Medical Care19 (10):1041-1055. |
Библиографическая ссылка |
Steen, P. M., A. C. Brewster, R. C. Bradbury, A. C. Estabrook, and J. A. Young. 1993. Predicted Probability of Hospital Death as a Measure of Admission Severity of Illness. Inquiry30 (2):128-141. |
Библиографическая ссылка |
Thomas, J. W., and M.L.F. Ashcraft. 1989. Measuring Severity of Illness: A Comparison of Interrater Reliability among Severity Methodologies. Inquiry26 (winter):483-492. |
Библиографическая ссылка |
Thomas, J. W., and M.L.F. Ashcraft1991. Measuring Severity of Illness: Six Severity Systems and Their Ability to Explain Cost Variations. Inquiry28 (1):39-55. |
Библиографическая ссылка |
U.S. Department of Health and Human Services. 1993. State Profile Data System: Characteristics of Medicaid State Programs. Health Care Financing Administration. HCFA Pub. No. 10130. Washington, D.C.: U.S. Department of Health and Human Services. |
Библиографическая ссылка |
Wade, M., and S. Berg. 1995. Causes of Medicaid Expenditure Growth. Health Care Financing Review16 (3):11-25. |
Библиографическая ссылка |
Wallen, J.1986. Case Mix and Treatment Patterns of Medicaid and Privately Insured Psychiatric Patients in Short-Term General Hospitals. Hospital Cost and Utilization Project Research Note 9; DHHS Publication No. (PHS) 87-3402. Washington, D.C.: U.S. Department of Health and Human Services. |
Библиографическая ссылка |
Weiner, S., J. Maxwell, H. Sapolsky, D. L. Dunn, and W. C. Hsiao. 1987. Economic Incentives and Organizational Realities: Managing Hospitals under DRGs. Milbank Quarterly65 (4):463-487. |
Библиографическая ссылка |
Welch, W. P., and M. Wade. 1995. The Relative Cost of Medicaid Enrollees and the Commercially Insured in HMOs. Health Affairs14 (2):212-223. |
Библиографическая ссылка |
Wennberg, J. E., B. A. Barnes, and M. Zubkoff. 1982. Professional Uncertainty and the Problem of Supplier-Induced Demand. Social Science and Medicine16:811-824. |
Библиографическая ссылка |
Wenneker, M. B., J. S. Weissman, and A. M. Epstein. 1990. The Association of Payer with Utilization of Cardiac Procedures in Massachusetts. Journal of the American Medical Association264 (10):1255-1260. |
Библиографическая ссылка |
White, C. L., A. Bateman, W. H. Fisher, and J. L. Geller. 1995. Factors Associated with Admission to Public and Private Hospitals from a Psychiatric Emergency Screening Site. Psychiatric Services46 (5):467-472. |
Библиографическая ссылка |
Yergan, J., A. B. Flood, P. Diehr, and J. P. LoGerfo. 1988. Relationship between Patient Source of Payment and the Intensity of Hospital Services. Medical Care26 (11):1111-1114. |