Economics of managed care in spinal cord injury.
OBJECTIVE
To determine and describe trends in economic variables related to the care of individuals with spinal cord injury (SCI) and significant changes in these trends coincident with major developments in medical care cost control.


METHODS
Data from the National Spinal Cord Injury Statistical Center (NSCISC) database were used to review the economic trends in SCI management from 1973 to 1998 and their relation to managed care and other health care cost-containment measures. A panel of SCI health care specialists was interviewed to determine the appropriate data variables to be reviewed. The Shepherd Center Care Health Management Program, Atlanta, GA, is presented as an example of a fiscally successful managed care program for patients with SCI.


METHODS
Data from the NSCISC database for the years studied were extracted and converted to a form suitable for analysis by means of the statistical software SAS.


RESULTS
Statistical techniques included multiple regression analysis, logistic regression analysis, and model selection methods.


CONCLUSIONS
Trends in economic variables, in the care of individuals with SCI show changes coincident with the introduction of Diagnostic Related Groups (DRGs) and managed care as models for provider reimbursement. Significant changes occurred in acute care charges, rehabilitation charges, length of stay, rehospitalization 1 year postinjury, time from injury to admission to a Model System, and discharges to a nursing home.
Fiedler
I G
IG
Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee 53226, USA.
Laud
P W
PW
Maiman
D J
DJ
Apple
D F
DF
D003363:Cost Control / Q000706:statistics & numerical data; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005251:Fees, Medical / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008329:Managed Care Programs / Q000191:economics* / Q000639:trends; D012047:Rehabilitation Centers / Q000191:economics*; D013119:Spinal Cord Injuries / Q000191:economics*