 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
|
| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Diane Dewar, PhD, Department of Health Policy, Management, and Behavior, School of Public Health--University at Albany, One University Place, Rensselaer, NY 12144-3456, 518-402-0290, ddewar@albany.edu and James Lambrinos, PhD, Graduate Managment Institute, Union College, Lamont House, Schenectady, NY 12308.
This paper investigates the impact hospital reimbursement system changes in New York State on end of life care for patients discharged under DRG 483 and DRG 475. The study determines 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:
Keywords: Access and Services, End-of-Life Care
Presenting author's disclosure statement:
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.