Does managed care make a difference? Physicians' length of stay decisions under managed and non-managed care

Jong, Judith de; Westert, Gert P.; Noetscher, Cheryl M.; Groenewegen, Peter

doi:10.1186/1472-6963-4-3

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…The result is consistent with findings from previous studies. 14 , 15 De Jong et al 15 explained that health maintenance organizations’ (HMOs) utilization management strategies and financial incentives for physicians significantly influences physicians’ LOS decisions. In addition, there is less variation in LOS for managed care patients because physicians face similar constraints and incentives from HMO insurance.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there is less variation in LOS for managed care patients because physicians face similar constraints and incentives from HMO insurance. 15 Following the methodology of De Jong et al, 15 this study examined some DRGs that were frequent among Medicaid patients in terms of mean and variation differences between Medicaid managed care and Medicaid FFS patients (see Supporting Information ). For most DRGs, Medicaid managed care patients had shorter LOS and more similar LOS than did FFS Medicaid patients.…”

Section: Discussionmentioning

confidence: 99%

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Length of Stay and Inpatient Costs Under Medicaid Managed Care in Florida

Park

2015

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This study examines the patterns of length of stay (LOS) and inpatient costs for both Medicaid managed care and nonmanaged care patients using data from Medicaid patients aged 18 to 64 years who were discharged from hospitals in Florida between 2006 and 2012. This study used pooled cross-sectional multilevel modeling. The results show that the type of Medicaid program in which patients were enrolled was significantly related to the hospital LOS and inpatient costs. Medicaid managed care patients had 7% shorter LOSs and a 1.9% lower inpatient cost than did Medicaid fee-for-service (FFS) patients. Medicaid managed care patients had shorter LOSs in the Medicaid managed care market with high competition. High managed care penetration generates a cost-decreasing spillover to Medicaid FFS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Length of Stay and Inpatient Costs Under Medicaid Managed Care in Florida

Park

2015

INQUIRY

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“…The introduction of prospective payment systems and their diffusion (Kimberly and De Pouvourville 1993) and managed care practices have greatly restricted the freedom of choice of physicians (Kerr et al 1995;Mechanic 2000;Simon et al 1998;De Jong et al 2004).…”

Section: Introductionmentioning

confidence: 99%

Is there a time trend in medical practice variations?

Groenewegen

Westert

2004

Journal of Public Health

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The aim of this study was to review the research evidence for a decreasing time trend in medical practice variation and to contribute to our theoretical understanding of trends in medical practice variations. We searched PubMed for articles reporting on time trends in medical practice variations. Eleven relevant articles were identified. The studies we found tend to show a downward trend in practice variation. Six of the eleven studies show a decrease in practice variation, three studies report more or less stable variation, and only two show increasing variation. The number of studies is, however, small and the aspects of medical practice that were studied in these articles are diverse. A trend in medical practice variation can probably best be explained by institutional changes within and outside health care, which on the one hand directly lead to decreased practice variation and on the other hand make the working environment of physicians more uniform.

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“…SPARCS is a major management tool assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state. Several research articles have been published that are based on SPARCS data (Pasley, Lagoe, and Marshall 1995;Westert and Lagoe 1995;Hainsworth et al 1997;Lagoe 1998;Murphy, Noetscher, and Lagoe 1999;Noetscher et al 1999;Lagoe, Noetscher, and Murphy 2001;Noetscher, Morreale, and Lagoe 2001;de Jong et al 2004). We used 1999We used , 2000We used , and 2001 SPARCS data to study seven diagnosisrelated groups (DRGs): two medical (DRGs 88 and 127), one surgical (DRG 209), and four obstetrical (DRGs 358,359,370,and 371).…”

Section: Description Of the Datamentioning

confidence: 99%

Variation in Hospital Length of Stay: Do Physicians Adapt Their Length of Stay Decisions to What Is Usual in the Hospital Where They Work?

Jong

Westert²,

Lagoe³

et al. 2005

Health Services Research

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Objective. To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. Data Sources. Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state. Study Design. Data on length of stay for surgical interventions and medical conditions (a total of seven diagnosis-related groups [DRGs]) were studied, to find out whether there is more variation between than within hospitals. Data (1999Data ( , 2000Data ( , and 2001) from all hospitals in New York state were used. The study examined physicians practicing in one hospital and physicians practicing in more than one hospital, to determine whether average length of stay differs according to the hospital of practice. Multilevel models were used to determine variation between and within hospitals. A t-test was used to test whether length of stay for patients of each multihospital physician differed from the average length of stay in each of the two hospitals. Principal Findings. There is significantly ( po.05) more variation between than within hospitals in most of the study populations. Physicians working in two hospitals had patient lengths of stay comparable with the usual practice in the hospital where the procedure was performed. The proportion of physicians working in one hospital did not have a consistent effect for all DRGs on the variation within hospitals. Conclusion. Physicians adapt to their colleagues or to the managerial demands of the particular hospital in which they work. The hospital and broader work environment should be taken into account when developing effective interventions to reduce variation in medical practice.

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Does managed care make a difference? Physicians' length of stay decisions under managed and non-managed care

Abstract: Background: In this study we examined the influence of type of insurance and the influence of managed care in particular, on the length of stay decisions physicians make and on variation in medical practice.

Cited by 8 publications

References 20 publications

Length of Stay and Inpatient Costs Under Medicaid Managed Care in Florida

Length of Stay and Inpatient Costs Under Medicaid Managed Care in Florida

Is there a time trend in medical practice variations?

Variation in Hospital Length of Stay: Do Physicians Adapt Their Length of Stay Decisions to What Is Usual in the Hospital Where They Work?

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