title: Age, resource consumption, and outcome for medical patients at an academic medical center.
abstract: At the national level debate is growing about the effects of the diagnosis related group (DRG) hospital payment system on patient access and quality of care. Recent changes to the DRG system have dropped any stratification by age and have delayed any other major change to improve payment equity. We characterized hospital resource consumption and outcome by age for all medical admissions (N = 31,838) to a large academic medical center (January 1, 1985, through December 31, 1987) using the DRG format. Mean hospital cost per patient, hospital length of stay, percentage of outliers, and mortality increased with age. The mean DRG case-mix index and the number of diagnostic codes per patient also rose with age. The DRG payment for all patients would have produced an aggregate profit of $34,426,951 ($1081 profit per patient); however, patients aged 71 years or older generated loses (the highest with patients aged 85 years or older--a $2177 loss per patient). As the financial position of American hospitals continues to deteriorate, these data suggest that the current DRG payment scheme may be inequitable for the medical patient aged 71 years or older, thus providing financial disincentives to treat the elderly medical patient and perhaps limiting their access and quality of care in the future.
authors.affiliation: University of Medicine and Dentistry of New Jersey, University Hospital, Newark 07103-2425.
authors.forename: E
authors.initials: E
authors.lastname: Muñoz
authors.forename: F
authors.initials: F
authors.lastname: Rosner
authors.forename: D
authors.initials: D
authors.lastname: Chalfin
authors.forename: J
authors.initials: J
authors.lastname: Goldstein
authors.forename: I
authors.initials: I
authors.lastname: Margolis
authors.forename: L
authors.initials: L
authors.lastname: Wise
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D035082:Federal Government; D006295:Health Resources / Q000706:statistics & numerical data*; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D009519:New York City; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D018579:Patient Selection; D011445:Prospective Payment System; D040841:Resource Allocation