title: Small-area analysis of gastrointestinal disease hospital discharge variation: are the poor at risk?
abstract: Capitation plans may place their enrollees at risk of rationed services if they do not adjust for underlying patient characteristics that dictate differing levels of care. To assess the degree to which population-based socioeconomic characteristics are associated with hospital use, this study explored small-area variation in hospital discharges for gastrointestinal and liver (GI) Diagnosis Related Groups (DRGs). Utilizing a 1980 Michigan database of 1.5 million discharges, we constructed age-adjusted, population-based discharge rates for the GI DRGs. We then evaluated the effect of poverty, defined by the percent of households in a hospital market community below the poverty line. Using regression techniques, we found that poverty explained 27.5% of the variation in GI hospital discharges, with the poor admitted more often (p less than 0.0001). Using cost weighted discharge rates as the dependent variable, we found that poverty explained 20.3% (p = 0.0003) of the variation in cost weighted discharges. These results suggest that poverty explains a significant amount of variation in hospital discharges and has a significant effect on associated small-area hospitalization costs in GI diseases. Practicing gastroenterologists and surgeons need to be aware of factors that influence patients utilizing their services in order to retain their role as patient advocates as changes in payment systems are suggested.
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor 48109-0376.
authors.forename: L F
authors.initials: LF
authors.lastname: McMahon
authors.forename: P J
authors.initials: PJ
authors.lastname: Tedeschi
authors.forename: R A
authors.initials: RA
authors.lastname: Wolfe
authors.forename: J R
authors.initials: JR
authors.lastname: Griffith
authors.forename: C G
authors.initials: CG
authors.lastname: McLaughlin
mesh_terms: D002204:Capitation Fee; D003362:Cost-Benefit Analysis; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000191:economics*; D006801:Humans; D008824:Michigan; D010344:Patient Advocacy; D010351:Patient Discharge / Q000191:economics* / Q000706:statistics & numerical data; D011203:Poverty; D012959:Socioeconomic Factors