Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescents

• Published in: American journal of public health (1971) 1999-09, Vol.89 (9), p.1353-1358
• Main Authors: Wickizer, T M, Lessler, D, Boyd-Wickizer, J
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Health Services - economics; Adolescent Health Services - statistics & numerical data; Age; Biological and medical sciences; Child; Child Health Services - economics; Child Health Services - statistics & numerical data; Child, Preschool; Children & youth; Concurrent Review; Cost Control; Economy. Management; Factors; Fee-for-Service Plans - economics; Female; Group insurance; Health and social institutions; Health care delivery; Health care expenditures; Health care policy; Health maintenance organizations; Health Services Research; HMOs; Hospitalization; Hospitals; Humans; Infant; Infant, Newborn; Length of stay; Length of Stay - statistics & numerical data; Male; Managed care; Managed Care Programs - economics; Managed health care; Medical sciences; Mental health; Multivariate Analysis; Patient Readmission - statistics & numerical data; Patients; Pediatrics; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Health Care; Readmission; Regression analysis; Restrictions; Sick children; Teenagers; United States; USA
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.89.9.1353

This study examined the effects of a utilization management program on patterns of medical care among children and adolescents. From 1989 through 1993, the program conducted 8568 reviews of pediatric patients, ranging in age from birth to 18 years. The program used preadmission and concurrent review procedures to review and certify patients' need for care. This study used multivariate analyses to assess changes in the number of days of inpatient care approved by the program and to determine whether limitations imposed on length of stay affected the risk of 60-day readmission. Concurrent review reduced the number of requested days of inpatient care by 3.2 days per patient. Low-birthweight infants and adolescent patients with depression or alcohol or drug dependence accounted for a disproportionate share of the reduction. Patients classified as admitted for medical or mental health care and whose stay was restricted by concurrent review were more likely (P < .05) to be readmitted within 60 days after discharge. By limiting care through its review procedures, the utilization management program decreased inpatient resource consumption but also increased the risk of readmission for some patients. Continued investigation should be conducted of the effects of cost-containment programs on the quality of care given to children and adolescents, especially in the area of mental health.