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Differences in Length of Hospital Stay for Medicaid and Blue Cross Patients and the Effect of Intensity of Services

James Studnicki
Public Health Reports (1974-)
Vol. 94, No. 5 (Sep. - Oct., 1979), pp. 438-445
Stable URL: http://www.jstor.org/stable/4596161
Page Count: 8
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Since scans are not currently available to screen readers, please contact JSTOR User Support for access. We'll provide a PDF copy for your screen reader.
Differences in Length of Hospital Stay for Medicaid and Blue Cross Patients and the Effect of Intensity of Services
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Abstract

In Maryland acute-care hospitals, Medicaid patients consistently exhibit longer stays than Blue Cross patients for the same diagnoses. This Medicaid-Blue Cross length of stay gap tends to be larger for the diagnoses that require the longest average stays, generate the highest levels of costs and charges, and typically require surgical intervention. It has been speculated that length of stay differences are primarily a function of differences in intensity, that is, the quantity of services provided the patient per day. According to this explanation, the total amount of treatment for a given diagnosis is relatively uniform, but it can be given over a longer (low intensity) or shorter (high intensity) period. In an analysis of average length of stay and average total charges for 43 hospitals and 20 selected diagnostic groups, overall intensity of care was lower for Medicaid than for Blue Cross patients. However, for the individual hospital, longer stays for Medicaid patients were not consistently accompanied by lower intensity of treatment for Medicaid patients. Higher intensity of care for Medicaid patients was associated with low occupancy rates, regardless of length of stay differences. In addition, variation in the size of the difference between Medicaid and Blue Cross length of stay was most highly correlated with a measure of the hospital's financial dependence upon Medicaid income. In other words, hospitals in which Medicaid income represents a higher proportion of total expenses also tend to exhibit a larger difference between lengths of stay of Medicaid and Blue Cross patients. Although further research is necessary, this analysis suggests that, at least for some hospitals, levels of intensity and lengths of stay are clearly associated with financial necessity; that is, increases in both intensity and length of stay result in increased revenues for the hospital. The dilemma for researchers posed by this analysis is the failure to conceptualize a method of trading off various costs (represented by intensity and length of stay) against the quality of services rendered in the hospital.

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