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

Table 4 Inpatient mortality for patients with Medicare and private insurance, comparing managed care to fee-for-service plans using a stringent definition of health maintenance organization, 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	61,159	0.97	0.91, 1.04		0.98	0.91, 1.04		1.01	0.94, 1.09		1.00	0.94, 1.08
Stroke	69,803	0.91	0.86, 0.97	↓	0.96	0.90, 1.03		0.99	0.92, 1.06		0.98	0.92, 1.05
Pneumonia	114,515	0.99	0.94, 1.06		1.03	0.97, 1.09		0.99	0.92, 1.06		1.05	0.98, 1.12
CHF	157,794	0.90	0.84, 0.95	↓	0.91	0.86, 0.97	↓	<did not converge>			0.93	0.87, 0.99	↓
Private managed care vs. private FFS
AMI	27,577	0.86	0.74, 1.00		0.88	0.75, 1.02		<did not converge>			0.88	0.74, 1.05
Stroke	21,510	0.87	0.78, 0.98	↓	0.88	0.78, 0.98	↓	1.02	0.88, 1.18		0.93	0.82, 1.07
Pneumonia	33,573	0.95	0.83, 1.08		0.92	0.80, 1.05		0.96	0.80, 1.14		0.93	0.80, 1.08
CHF	22,926	0.66	0.56, 0.78	↓	0.67	0.56, 0.79	↓	<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 3 states: California, New York, and Pennsylvania

ISSN: 1472-6963