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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >The impact of managed care insurance on use of lower-mortality hospitals by children undergoing cardiac surgery in California.
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The impact of managed care insurance on use of lower-mortality hospitals by children undergoing cardiac surgery in California.

机译：在加利福尼亚，接受心脏手术的儿童使用管理式医疗保险对使用低死亡率医院的影响。

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CONTEXT: Managed care plans aggressively seek to contain costs, but few data are available regarding their impact on access to high quality care for their members. OBJECTIVE: To assess the impact of managed care health insurance on use of lower-mortality hospitals for children undergoing heart surgery in California. DESIGN: Retrospective cohort study using state-mandated hospital discharge datasets. SETTING: Pediatric cardiovascular surgical centers in California. PATIENTS: Five thousand seventy-one children admitted for open cardiac surgical procedures during 1992-1994. RESULTS: Hospitals were divided into lower- and higher-mortality groups according to adjusted surgical mortality. Using multivariate logistic regression analysis to control for medical, socioeconomic, demographic, and distance factors, children with managed care insurance were less likely to be admitted to a lower-mortality hospital for surgery relative to children with indemnity insurance (odds ratio:.53; 95% confidence interval:.45,.63). Similar findings resulted when the analysis was stratified by race/ethnicity. In addition, length of stay, a correlate of health care costs, was no longer for children admitted to lower-mortality centers than for those at higher-mortality centers (adjusted difference:.54 days shorter at lower-mortality centers; 95% confidence interval: -1.50,. 41). CONCLUSIONS: During this study, children with managed care insurance had significantly reduced use of lower-mortality hospitals for pediatric heart surgery in California compared with children with indemnity insurance. Further study is necessary to determine the mechanisms of this apparent insurance-specific inequity.
机译：语境：管理式护理计划积极地寻求控制成本的方法，但是关于其对会员获得优质护理的影响的数据很少。目的：评估管理式医疗保险对加利福尼亚州接受心脏手术的儿童使用低死亡率医院的影响。设计：使用国家规定的出院数据集进行回顾性队列研究。地点：加利福尼亚州的儿科心血管外科中心。患者：1992-1994年间，有571名儿童接受了心脏直视手术。结果：根据调整后的手术死亡率将医院分为低死亡率和高死亡率两组。使用多元逻辑回归分析来控制医疗，社会经济，人口统计学和距离因素，与有弥偿保险的孩子相比，拥有管理照护保险的孩子被送往一家低死亡率医院接受手术的可能性较小（赔率：.53; 95％置信区间：.45，.63）。当按种族/民族对分析进行分层时，得出类似的结果。此外，入住低死亡率中心的儿童不再像高死亡率中心的儿童那样住院时间（与医疗保健费用相关）（调整差：低死亡率中心的儿童缩短了.54天;置信度为95％）间隔：-1.50，.. 41）。结论：在这项研究中，与有弥偿保险的孩子相比，有管理式医疗保险的孩子在加利福尼亚州使用较低死亡率的医院进行儿科心脏手术的人数明显减少。为了确定这种明显的针对保险的不平等的机制，有必要做进一步的研究。

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