Managed care and inpatient mortality in adults: effect of primary payer

Table 2 Inpatient mortality for patients with Medicare and private insurance, comparing managed care to fee-for-service plans, 2009

Measure	Sample size for managed care and FFS	Patient characteristics^a			Patient + hospital characteristics^b			Patient characteristics + hospital fixed effects			Patient + hospital characteristics + county fixed effects
Measure	Sample size for managed care and FFS	OR	95% CI	Difference^c	OR	95% CI	Difference^c	OR	95% CI	Difference^c	OR	95% CI	Difference^c
Medicare managed care vs. Medicare FFS
AMI	112,623	0.97	0.92, 1.02		0.98	0.93, 1.04		0.98	0.92, 1.04		0.98	0.93, 1.04
Stroke	122,525	0.93	0.89, 0.98	↓	0.98	0.93, 1.03		0.97	0.91, 1.03		0.98	0.93, 1.03
Pneumonia	211,921	1.03	0.98, 1.09		1.07	1.02, 1.13	↑	0.99	0.93, 1.05		1.05	0.99, 1.11
CHF	284,241	0.95	0.90, 0.99	↓	0.98	0.93, 1.03		<did not converge>			0.95	0.90, 1.00
Private managed care vs. private FFS
AMI	53,444	0.87	0.77, 0.97	↓	0.88	0.78, 0.98	↓	<did not converge>			0.86	0.76, 0.98	↓
Stroke	38,241	0.76	0.69, 0.83	↓	0.80	0.73, 0.87	↓	0.84	0.75, 0.94	↓	0.79	0.71, 0.87	↓
Pneumonia	64,683	0.90	0.82, 1.00		0.89	0.80, 0.99	↓	0.83	0.72, 0.95	↓	0.88	0.78, 0.98	↓
CHF	43,046	0.62	0.55, 0.70	↓	0.64	0.57, 0.73	↓	<did not converge>			<did not converge>

Abbreviations: AMI, acute myocardial infarction; CHF, congestive heart failure; CI, confidence interval; FFS, fee for service; OR, odds ratio
^aPatient characteristics were age, sex, All Patient Refined-Diagnosis Related Group (APR-DRG), and community income
^bHospital characteristics were bed size, ownership, teaching status, and urban/rural location
^cA down arrow indicates the mortality rate for managed care is significantly lower than FFS at p < 0.05. An up arrow indicates the mortality rate for managed care is significantly higher than FFS at p < 0.05
Source: Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, State Inpatient Databases, 2009, from the following 11 states: Arizona, California, Connecticut, Massachusetts, Michigan, Minnesota, New Hampshire, Nevada, New York, Ohio, and Pennsylvania

ISSN: 1472-6963