Hospital use in a fee-for-service system

F. T. Nobrega, I. Krishan, R. K. Smoldt, C. S. Davis, J. A. Abbott, E. G. Mohler and W. McClure

The population of Olmsted County, Minnesota, receives care virtually exclusively from two fee-for-service group practices: the Mayo Clinic and the Olmsted Medical and Surgical Group. Study of the use of acute-care hospital services by this population in 1976 reveals that the hospital discharge rate per 1,000 population, adjusted for age and sex, was 30% less than the national rate; the age-sex-adjusted rate of hospital days per 1,000 population was 38% less than the national rate. Analysis by length of stay, type of hospital service, frequency of selected diagnoses and surgical procedures, and certain demographic and economic characteristics did not explain the differences from national use rates. These rates are comparable, after age and sex adjustment, with those in larger prepaid group practices. The analysis suggests that the organization of medical care may have an important influence on hospital use.