This paper investigates the impacts of managed care and competitive hospital reimbursements on hospital resource utilization for critically ill patients discharged under DRG 483 and DRG 475 in New York State. The study goals are to determine whether the reduction in hospital length of stay among managed care patients is due to self-selection or the elimination of ineffective care in the inpatient setting. Discharge abstracts from the Statewide Planning and Research Cooperative System are used to identify clinical and hospital-driven determinants of resource utilization before and after the institution of competitive hospital reimbursements during 1995-1999. Identity-linked geometric regression models are used to test hypotheses concerning the impacts of managed care and reimbursement structures on the likelihood of hospital survival and length of stay. Preliminary findings show that patients’ managed care participation and the institution of competitive reimbursements decrease length of stay, controlling for clinical risk factors. However, the length of stay is longer for those who die in the hospital, and for hospitals that are large, have a larger proportion of managed care patients or are located in the New York City area. These findings inform public and private policy concerning the impact of managed care and reimbursement changes on overall resource utilization for the health care system’s sickest and most expensive patients.
Learning Objectives: The participant will be able to evaluate the impacts of health care financing and delivery system changes on resource utilization for the critically ill.
Keywords: Economic Analysis, Health Care Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.