Limited to 251,768 discharges during 1999 from short-term hospitals located in Oklahoma, the objective of this study was to examine the influence of insurance status, prospective payment, and the unit of payment on variation in the length of stay. The regression analysis indicated that elderly patients whose care was financed by the Medicare pricing system and the uninsured experienced a significantly shorter episode of hospitalization than their commercially insured counterparts. Conversely, Medicaid recipients, whose care was financed by a fixed per diem and uninsured or self-responsible patients, experienced a significantly shorter hospital stay than the commercially insured. The results also indicate that the type and source of admissions, the discharge destination of the patient, and case complexity significantly influenced the hospital stay. African-Americans and Native Americans also experienced a longer episode of hospital care than their white counterparts. The article concludes with a discussion of policy implications and the need to develop alternate methods of financing hospital care thereby reducing the risks of premature discharge and iatrogenic injury.
Get full access to this article
View all access options for this article.
References
1.
AndersonR. (1968). Behavioral Model of Families' Use of Health Services. Chicago: University of Chicago Center for Health Admistration, Research Series 25.
2.
AndersonR. and NewmanJ. (1973). “Societal and Individual Determininats of Medical Care Utilization in the United States.” Milbank Memorial Fund Quarterly51:95–124.
3.
BarkerW.. (1985). “Geriatric Consultation Teams in Acute Hospitals: Impact on Back-up of Elderly Patients.” Journal of the American Geriatric Society33:422.
4.
BrodyS. (1990). “The Robert Wood Foundation Case Management Program on Hospital Initiatives,” in WelgeR. (ed.). Long Term Care: Economic Impacts and Financing Dilemmas. Washington, D.C.: National Health Council.
5.
BroylesR. (1990). “Efficiency, Costs and Quality: The New Jersey Experience Revisited.” Inquiry27:86–96.
6.
BroylesR.W., NarineL., and BrandtE.N. (2000). “Health Risks, Ability to Pay and the Use of Primary Care: Is the Distribution of Service Effective and Equitable?” Preventive Medicine30(1):453–462.
7.
BroylesR.W., NarineL., and BrandtE.N. (2002). “The Temporarily and Chronically Uninsured: Does Their Use of Primary Care Differ?” Journal of Healthcare for the Poor and Underserved13(1):95–222.
8.
BroylesR. and RoskoM. (1985). “A Qualitative Assessment of the Medicare Payment System.” Social Science and Medicine10:1185–1190.
9.
CunninghamP. and AltmanV. (1993). “The Use of Ambulatory Health Care by American Indians with Disabilities.” Medical Care23:600–615.
10.
FalconeD. and BroykesR. (1993). “What Type of Patients Wait for Alternative Placement? Findings from an Exploratory Case Study and Policy Implications.” Journal of Aging and Social Policy5:77–98.
11.
FalconeD. and BroykesR. (1994). “Access for Long-Term Care: Race as a Barrier.” Journal of Health Politics, Policy and Law19:583–595.
12.
FalconeD., BoldaE., and Crawford LeakS. (1991). “Waiting for Placement: An Exploratory Analysis of Determinants of Delayed Hospital Discharges of Elderly Patients.” Health Services Research26:339–374.
13.
FieldsS.. (1986). “Cognitive Impairment: Can It Predict the Cause of Hospitalized Patients?” Journal of the American Geriatric Society34:579–585.
14.
FreemanH. and CoreyC. (1993). “Insurance Status and Access to Health Services among Poor Persons.” Health Services Research28: 531–541.
15.
GlassR.. (1977). “The 4 Score: An Index for Predicting a Patient's Non-medical Hospital Days.” American Journal of Public Health67:751.
16.
GoehedesD. and ActonK. (2000). “Mellitus and its Complications,” in RhodesE. (ed.), American Indian Health Innovations in Health Care, Promotion and Policy. Baltimore: Johns Hopkins University Press.
17.
Hafner-EatonC. (1992). “Physician Utilization Disparities Between the Uninsured and Insured: Comparisons of the Chronically Ill, Acutely Ill, and Well Nonelderly Population.” Journal of the American Medical Association269, 787–792.
18.
HsiaoW. and DunnD. (1987). “The Impact of DRG Payments on New Jersey Hospitals.” Inquiry24:203–214.
19.
MahoneyM. and MichalekA. (1998). “Health Status of American Indians/Alaska Natives: General Patterns of Mortality.” Family Medicine30:190–195.
20.
MasseyD. and DentonN. (1989). “Hypersegregation in U.S. Metropolitan Areas: Blacks and Hispanic Segregation along Five Dimensions.” Demography26:373–391.
21.
Medicare Payment Advisory Committee (2001). “Report to the Congress, MedPac.”Washington, D.C.: Author.
22.
MillmanM. (1993). Access to Personal Health Care in America: Report of the Committee on Monitoring Access to Personal Health Care Services. Washington, D.C.: National Academy Press.
23.
National Heart, Lung and Blood Institute (1988). The 1988 Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. Washington, D.C.: Department of Health and Human Services.
24.
PolderJ.. (2003). “A Costminimisation Study of Alternate Discharge Policies after Hip Fracture Repair.” Health Economics12:87–100.
25.
PrimeauxM. (1977). “American Indian Health Practices: A Cross Culural Perspectives.” Nursing Clinics of North America12:55–72.
26.
RoskoM. and BroylesR. (1987). “Short-term Responses of Hospitals to the DRG Prospective Pricing Mechanism in Mew Jersey.” Medical Care25:88–99.
27.
SmithD. (1990). “Population Ecology and the Racial Integration of Hospitals and Nursing Homes in the United States.” Milbank Quarterly6:561–596.
28.
VarnvaA.. (2002). “Restricted Weekend Service Inappropriately Delays Discharge after Myocardial Infarction.” Annals of Cardopvascular Medicine87:216–219.
29.
WeismanJ.. (1991). “Delayed Access to Health Care: Risk Factors, Reasons and Consequences.” Annals of Internal Medicine114:325–331.
30.
WeissertW. and CleadyC. (1998). “Determinants of Hospital-to-Nursing Home Placement Delays: A Pilot Study.” Health Services Research23:619–647.
31.
WelleverA., HillG., and CaseyM. (1998). “Medicaid Reform Issues Affecting the Indian Health Care System.” American Journal of Public Health88:193–195.
32.
WennekerM. and EpsteinA. (1989). “Racial Inequalities in the Use of Procedures for Patients with Ischemic Heart Disease in Massachusetts.” Journal of the American Medical Association261:253–257.
