title: Failure of Medicare health maintenance organizations to control the cost of colon resections in elderly patients.
abstract: OBJECTIVE
  Medicare health maintenance organizations (HMOs) do not reduce the cost of colon resections in elderly patients.
  
  
  METHODS
  Review of prospectively collected and mandatory reported Florida hospital discharge data from January 1, 1995, through December 31, 1999. We used the chi(2) test for trend analysis to assess significant change in age, mortality, and complications, and the Kruskal-Wallis test to compare inflation-adjusted hospital charges, comorbidity, length of stay, and secondary procedures.
  
  
  METHODS
  Administrative database including all community- and university-based surgeons.
  
  
  METHODS
  All patients 70 years or older who underwent colon resection from 1995 through 1999.
  
  
  METHODS
  Age, mortality, complications, length of stay, number of comorbidities and secondary procedures, hospital charges, and type of colon resection.
  
  
  RESULTS
  The frequency of different colon resections increased by 10% to 30% from 1995 through 1999. Total hospital charges increased during the study period (P<.001), whereas mortality and complications remained unchanged. Length of stay, number of secondary procedures, and comorbidities were the most significant contributors to hospital charges. Despite a significantly shorter hospital stay, Medicare HMO patients had similar hospital charges to those of original Medicare patients.
  
  
  CONCLUSIONS
  Colon resections can be undertaken in elderly patients with acceptable morbidity. Per diem charges were higher for patients covered by Medicare HMO, despite their having shorter lengths of stay, fewer comorbidities, and fewer secondary procedures.
authors.affiliation: Department of Surgery and School of Public Health, University of South Florida Health Sciences Center, Tampa, USA.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Sung
authors.forename: Mike
authors.initials: M
authors.lastname: Wessel
authors.forename: Scott F
authors.initials: SF
authors.lastname: Gallagher
authors.forename: Jorge
authors.initials: J
authors.lastname: Marcet
authors.forename: Michel M
authors.initials: MM
authors.lastname: Murr
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000191:economics*; D003363:Cost Control; D005431:Florida; D006279:Health Maintenance Organizations; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D006278:Medicare