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Health Serv Res. 1998 Feb;32(6):759-74.

A longitudinal study of hospitalization rates for patients with chronic disease: results from the Medical Outcomes Study.

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  • 1Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.

Abstract

OBJECTIVE:

To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease.

DATA SOURCE/STUDY SETTING:

Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles.

STUDY DESIGN:

A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians.

DATA COLLECTION/EXTRACTION METHODS:

Insurance payment system (PPD or FFS), hospitalizations, and office visits were obtained from patient reports. Disease and severity indicators, sociodemographics, and self-reported functional status were used to adjust for patient mix and to compute expected utilization rates.

PRINCIPAL FINDINGS:

Compared to FFS, PPD patients had 31 percent fewer observed hospitalizations before adjustment for patient differences (p = .005) and 15 percent fewer hospitalizations than expected after adjustment (p = .078). The observed rate of FFS hospitalizations exceeded the expected rate by 9 percent. These results are not explained by system differences in patient mix or trends in hospital use over four years. Half of the PPD/FFS difference in hospitalization rate is due to intrinsic characteristics of the payment system itself.

CONCLUSIONS:

PPD patients with chronic medical conditions followed prospectively over four years, after extensive patient-mix adjustment, had 15 percent fewer hospitalizations than their FFS counterparts owing to differences intrinsic to the insurance reimbursement system.

PMID:
9460485
[PubMed - indexed for MEDLINE]
PMCID:
PMC1070232
Free PMC Article
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