Managed care for XXXX : influence of payer status on process of care, resource utilization, and short-term outcomes.

@entity1 @entity712 @entity204 @entity347
BACKGROUND: Although @entity347 ( @entity347 ) are insuring an increasing number of Americans, there are concerns that cost-reduction strategies may limit access to medical care or jeopardize its quality. This study was conducted to examine the influence of insurance payer status on the process of care and resource utilization among @entity1 hospitalized for @entity712 ( @entity712 ). METHODS AND RESULTS: Administrative information on all 1995 New York State hospital discharges assigned ICD-9-CM codes indicative of @entity712 in the principal diagnosis position were obtained from the Statewide Planning and Research Cooperative System database. The following were compared among @entity1 with @entity347 , indemnity, Medicaid fee-for-service, and Medicare fee-for-service insurance coverage: demographics, comorbid illness, process of care, length of stay, hospital charges, mortality rate, and @entity712 readmission rate. A total of 43,157 @entity1 were identified ( @entity347 , 1322; indemnity, 4350; Medicaid, 3878; Medicare, 33 607). Noninvasive procedures were used with similar frequency, whereas greater use of invasive techniques was observed among @entity347 and indemnity @entity1 . After adjustment for @entity1 characteristics and hospital type and location, @entity347 care was associated with shorter length of stay and lower hospital charges, the latter partially explained by fewer hospital days. Medicaid @entity1 had the longest length of stay, greatest hospital charges, and highest @entity712 readmission rate. The adjusted risk of @entity204 during the index hospitalization did not vary among insurance groups. CONCLUSIONS: Though insuring only a small proportion of New Yorkers hospitalized for @entity712 , managed care plans provide similar access to clinical services while generating fewer charges. Whether these observed differences in short-term outcomes derive from @entity1 mix or quality of care is uncertain and deserves wider prospective study.
