Impact of Health System Affiliation on Hospital Resource Use Intensity and Quality of Care.

Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.

Hospital Administration*; Delivery of Health Care, Integrated/*organization & administration ; Hospitals, Community/*organization & administration ; Managed Care Programs/*organization & administration ; Quality of Health Care/*organization & administration; Adult ; Aged ; Delivery of Health Care, Integrated/economics ; Female ; Health Services Research ; Hospital Bed Capacity ; Hospital Costs ; Hospitals, Community/economics ; Humans ; Length of Stay ; Longitudinal Studies ; Male ; Managed Care Programs/economics ; Middle Aged ; Ownership ; Patient Discharge/economics ; Quality Indicators, Health Care ; Quality of Health Care/economics ; Retrospective Studies ; Socioeconomic Factors ; United States

Objective: To assess the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality.
Data Sources: Inpatient discharges from 3,957 community hospitals in 44 states and American Hospital Association Annual Survey data from 2010 to 2012.
Study Design: We conducted a retrospective longitudinal regression analysis using hierarchical modeling of discharges clustered within hospitals.
Data Collection: Detailed discharge data including costs, length of stay, and patient characteristics from the Healthcare Cost and Utilization Project State Inpatient Databases were merged with hospital survey data from the American Hospital Association.
Principal Findings: Hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge and better quality of care compared with other independent hospitals.
Conclusions: Increasing prevalence of health systems and hospital managed care ownership may lead to higher quality but are unlikely to reduce hospital discharge costs. Encouraging participation in innovative payment and delivery reform models, such as accountable care organizations, may be more powerful options.
(© Health Research and Educational Trust.)

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Keywords: Centralization; cost; health systems; hospitals; quality indicators

Date Created: 20161223 Date Completed: 20190107 Latest Revision: 20190201

20250114

PMC5785316

10.1111/1475-6773.12631

28004380