Payment effects on resource utilization and outcomes for patients with congestive heart failure

Abstract

This investigation focuses on patients hospitalized with congestive heart failure (CHF) to evaluate the effects of insurance status on resource utilization (costs and procedure intensity), and the process of inpatient care (length of stay). Data include hospital discharge claims from fourteen states across the U.S. for 88,000 primary and another 135,000 secondary CHF patients under age 65. Risk adjustment methods control for clinical, demographic, and risk selection factors in order to isolate the effects of insurance status on the variables of interest.Results indicate that insurance status significantly affects the type and intensity of care. Lengths of stay are shortest for privately managed patients and longest for patient in public programs. Nonetheless access to high intensity treatment procedures favors private payors, especially those covered by indemnity plans. Overall hospitalization and treatment costs are less sensitive to payor status than length of stay and appear to be driven by high intensity procedure utilization. The marginal effects of CHF are substantial, raising length of stay and treatment cost by up to 40% and reinforcing the insurance status effect on length of stay and utilization found in patients hospitalized with CHF as a primary diagnosis. Despite these process-of-care differences, no significant inpatient mortality/morbidity differences were ascertained in either the primary or secondary analyses.

Citation

Kroch, E., Shah, R., Fisher, D., Loh, E. and Sanford Schwartz, J. (2001), "Payment effects on resource utilization and outcomes for patients with congestive heart failure", Farquhar, I., Summers, K. and Sorkin, A. (Ed.) Investing in Health: The Social and Economic Benefits of Health Care Innovation (Research in Human Capital and Development, Vol. 14), Emerald Group Publishing Limited, Leeds, pp. 411-449. https://doi.org/10.1016/S0194-3960(01)14017-5