title: Does managed care more efficiently allocate resources to older patients in critical care settings?
abstract: OBJECTIVE
  To evaluate resource utilization by elderly patients with respiratory failure in order to compare the efficiency of managed care and non-managed care payers.
  
  
  METHODS
  Regression analysis is applied to predict survival rate and the payments per life saved as a function of managed care participation, sociodemographics, and clinical risk factors.
  
  
  METHODS
  Acute care hospitals in New York State.
  
  
  METHODS
  Patients discharged under DRG 483 during 1992-1996.
  
  
  METHODS
  None.
  
  
  RESULTS
  Predicted payments were compared to the value of extending life for each payer subset, with and without quality of life adjustments, in order to determine when net benefits were maximized. Payments per life saved increased steadily for both groups (managed care and non-managed care) with age, with the non-managed care payments increasing more rapidly than managed care payments. Benefits equaled costs in the same age ranges for both payer groups, although the age at which benefits equaled costs was 93 for managed care patients and 91 for non-managed care patients. Resources are allocated efficiently for most patients regardless of payer.
  
  
  CONCLUSIONS
  Managed care patients with DRG483 had higher rates of survival. Resource utilization efficiency was not affected by payer source.
authors.affiliation: HPEN, Inc., Los Angeles, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Dewar
authors.forename: J
authors.initials: J
authors.lastname: Lambrinos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000191:economics; D003953:Diagnosis-Related Groups / Q000191:economics; D017598:Efficiency, Organizational; D005260:Female; D015276:Health Care Rationing; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000191:economics*; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000458:organization & administration; D008875:Middle Aged; D017059:Models, Econometric; D009518:New York; D012121:Respiration, Artificial / Q000191:economics*; D016019:Survival Analysis; D014139:Tracheostomy / Q000191:economics*; D026712:Value of Life