Does managed care more efficiently allocate resources to older patients in critical care settings?

To evaluate resource utilization by elderly patients with respiratory failure in order to compare the efficiency of managed care and non-managed care payers.

Regression analysis is applied to predict survival rate and the payments per life saved as a function of managed care participation, sociodemographics, and clinical risk factors.

Acute care hospitals in New York State.

Patients discharged under DRG 483 during 1992-1996.

None.

Predicted payments were compared to the value of extending life for each payer subset, with and without quality of life adjustments, in order to determine when net benefits were maximized. Payments per life saved increased steadily for both groups (managed care and non-managed care) with age, with the non-managed care payments increasing more rapidly than managed care payments. Benefits equaled costs in the same age ranges for both payer groups, although the age at which benefits equaled costs was 93 for managed care patients and 91 for non-managed care patients. Resources are allocated efficiently for most patients regardless of payer.

Managed care patients with DRG483 had higher rates of survival. Resource utilization efficiency was not affected by payer source.