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Evidence on the Efficacy of Inpatient Spending on Medicare Patients
Author(s) -
KAESTNER ROBERT,
SILBER JEFFREY H.
Publication year - 2010
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/j.1468-0009.2010.00612.x
Subject(s) - medicine , inpatient care , myocardial infarction , context (archaeology) , emergency medicine , incentive , stroke (engine) , health care , heart failure , medical care , intensive care medicine , economics , mechanical engineering , paleontology , engineering , biology , microeconomics , economic growth
Context: It is widely believed that a significant amount, perhaps as much as 20 to 30 percent, of health care spending in the United States is wasted, despite market forces such as managed care organizations and large, self‐insured firms with a financial incentive to eliminate waste of this magnitude. Methods: This article uses Medicare claims data to study the association between inpatient spending and the thirty‐day mortality of Medicare patients admitted to hospitals between 2001 and 2005 for surgery (general, orthopedic, vascular) and medical conditions (acute myocardial infarction [AMI], congestive heart failure [CHF], stroke, and gastrointestinal bleeding). Findings: Estimates from the analysis indicated that except for AMI patients, a 10 percent increase in inpatient spending was associated with a decrease of between 3.1 and 11.3 percent in thirty‐day mortality, depending on the type of patient. Conclusions: Although some spending may be inefficient, the results suggest that the amount of waste is less than conventionally believed, at least for inpatient care.