PATTERNS OF DECLINE AMONG INPATIENT PROCEDURES

THIS PAPER EXPLORES how the new financial incentives and organizationa l structures that prevail in the hospital industry have affected the m ix of services provided by hospitals. Using data from the Agency for H ealth Care Policy and Research's Healthcare Cost and Utilization Proje ct, the authors studied the 150 procedures that were most frequently p erformed on inpatients in 1980, They found that (a) 37 of the 150 proc edures declined in use more than 40 percent by 1987, (b) patients that continued to receive one of the 37 procedures in 1987 on an inpatient basis tended to be more severely ill than in 1980, and (c) rates of d ecline were disproportionately large for Medicaid recipients. Three ma in factors have contributed to the decline in inpatient use of these p rocedures, Most important has been the shift from inpatient to outpati ent settings, a result of new technologies and pressures from reimburs ement mechanisms and utilization review policies, Some procedures have been replaced by less invasive, more effective approaches, Other proc edures are now considered ineffective by the medical community and hav e been largely abandoned as a result.