A longitudinal study of hospitalization rates for patients with chronic disease: results from the Medical Outcomes Study

UMMS Affiliation

Department of Quantitative Health Sciences

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Adult; Aged; Boston; Chicago; Chronic Disease; Fee-for-Service Plans; Female; Health Resources; Health Services Research; Hospitalization; Humans; Longitudinal Studies; Los Angeles; Male; Middle Aged; Prepaid Health Plans; Prospective Studies; Socioeconomic Factors


Biostatistics | Epidemiology | Health Services Research


OBJECTIVE: To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease.

DATA SOURCE/STUDY SETTING: Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles.

STUDY DESIGN: A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians.

DATA COLLECTION/EXTRACTION METHODS: Insurance payment system (PPD or FFS), hospitalizations, and office visits were obtained from patient reports. Disease and severity indicators, sociodemographics, and self-reported functional status were used to adjust for patient mix and to compute expected utilization rates.

PRINCIPAL FINDINGS: Compared to FFS, PPD patients had 31 percent fewer observed hospitalizations before adjustment for patient differences (p = .005) and 15 percent fewer hospitalizations than expected after adjustment (p = .078). The observed rate of FFS hospitalizations exceeded the expected rate by 9 percent. These results are not explained by system differences in patient mix or trends in hospital use over four years. Half of the PPD/FFS difference in hospitalization rate is due to intrinsic characteristics of the payment system itself.

CONCLUSIONS: PPD patients with chronic medical conditions followed prospectively over four years, after extensive patient-mix adjustment, had 15 percent fewer hospitalizations than their FFS counterparts owing to differences intrinsic to the insurance reimbursement system.


Health Serv Res. 1998 Feb;32(6):759-74. Link to article on publisher's site

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Health services research

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Link to Article in PubMed