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The Use of Hospital Care: Do Insurance Status, Propective Payment, and the Unit of Payments Make a Difference?

JHHSA, Vol. 25 No. 4, (2003)

Limited to 251,768 discharges during 1999 from short-term hospitals
located in Oklahoma, the objective of this study was to examine the
influence of insurance status, prospective payment, and the unit of
payment on variation in the length of stay. The regression analysis
indicated that elderly patients whose care was financed by the Medicare
pricing system and the uninsured experienced a significantly shorter
episode of hospitalization than their commercially insured counterparts.
Conversely, Medicaid recipients, whose care was financed by a fixed
per diem and uninsured or self-responsible patients, experienced a
significantly shorter hospital stay than the commercially insured. The
results also indicate that the type and source of admissions, the dis-
charge destination of the patient, and case complexity significantly
influenced the hospital stay. African-Americans and Native Americans
also experienced a longer episode of hospital care than their white
counterparts. The article concludes with a discussion of policy implica-
tions and the need to develop alternate methods of financing hospital
care thereby reducing the risks of premature discharge and iatrogenic

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