Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescents.

Abstract

Managed care plans and health insurance companies have adopted aggressive cost-containment strategies in response to competitive pressures and to the demand by health care payers for improved cost control. Little is known about the effects of these strategies on the delivery of medical care among adult patients, and almost nothing is known about their effects among children and adolescents.Utilization management (UM) is one of the most widely used approaches to health care cost containment. Current sion. By analyzing a case series of patients whose care was subject to UM, we obtained information on denials and restrictions resulting from UM-mandated preadmission authorization and concurrent review and were able to examine the effects of these restrictions on readmission. Because we did not have population-based comparison data on groups subjected to UM review and those not so subjected, however, we were unable to examine the sentinel effect ofUM on admissions. Methods Utilization Management ProgramUtilization management was conducted as part of a managed fee-for-service health care plan offered by a large commercial insurance carrier from 1989 onward. More than 500 groups, located in 47 states, adopted the insurance carrier's program with UM to promote cost containment. Health care for dependent children covered under the groups' respective policies became subject to the review procedures of the UM program. The groups to which the UM program applied had Thomas M. Wickizer is with, and at the time of the study Jodie Boyd-Wickizer was with, the Department

Symptom, Family, and Service Predictors of Children's Psychiatric Rehospitalization Within One Year of Discharge

“…Clustering of readmissions soon after discharge has been reported in other research with children and adolescents (Wickizer et al, 1999). If further research confirms this trend, interventions to reduce the rehospitalization period should focus on this period.…”

“…rehospitalization for children and adolescents (Wickizer et al, 1999). Readmission to inpatient care is therefore a frequent, unfavorable outcome for a growing patient group.…”

“…First, inpatient service use (length of stay and prior hospitalization) may influence the risk of rehospitalization (Appleby et al, 1993;Colenda and Hamer, 1989;Pavkov et al, 1997;Wickizer et al, 1999). Second, care-financing source (public versus private) may affect the threshold for rehospitalization (Dalton et al, 1997).…”

Reinternamentos Hospitalares num Serviço de Pedopsiquiatria: Taxa de Readmissão e Fatores de Risco

“…6,8,11 Alguns estudos apontam como fator de risco o internamento prolongado, embora apontem como viés a maior gravidade da patologia. [14][15][16][17][18] Por outro lado, internamentos de curta duração também foram associados a um maior risco de internamento pelo risco de não se ter atingido a estabilização da doença aquando da alta.…”

“…Mendes P, et al Reinternamentos hospitalares num serviço de pedopsiquiatria, Acta Med Port 2017 Nov;30 (11): [769][770][771][772][773][774] psicótica ou de perturbação do comportamento alimentar (PCA), 5 institucionalização, 5,7 comportamentos suicidá-rios, 5,7 dificuldades de aprendizagem, 5 duração do internamento 8,9,11 e falta de cuidados pedopsiquiátricos adequados pós-alta. 3,5,8,10 A história de reinternamentos repetidos é o fator de risco mais consistente na literatura.…”