Financial risk and hospital cost for elderly patients. Age- and non-age-stratified medical diagnosis related groups

The purpose of this study was to analyze hospital resource consumption for Medicare patients in non-age- and age-stratified medical diagnosis related groups (DRGs). This study of patients in 74 non-age-stratified DRGs (N = 3643) and 113 age-stratified DRGs (N = 2898) demonstrated that older medical patients (usually greater than or equal to 75 to 80 years of age) had (on average) higher total hospital costs, a longer hospital length of stay, more diagnoses per patient, a greater percentage of outliers, and a higher mortality compared with younger patients in these same DRGs. These findings raise the question of the equity of DRG payment vis-à-vis older Medicare patients in both non-age- and age-stratified medical DRGs. Financial disincentives to treat older medical patients may limit both their access and quality of care in the future.

Urban development patterns in Indonesia

The author examines recent urban development in Indonesia. "Analysis of urban developments in Indonesia has been hampered in the past by weak data. Recently, the National Urban Development Strategy (NUDS) project has generated a set of improved data. This paper aims at elaborating and supplementing the NUDS study. After a discussion of definitional problems, an analysis is carried out of urban growth rates at the provincial level. Private investment is shown to be a principal determinant of urban growth rates. Other significant determinants are rural immigration and the present level of urbanisation. Private investment is shown to be strongly biased towards provinces with large urban areas. In addition, polarisation is studied at the level of individual cities. It is found that a period of rapidly increasing polarisation has come to an end during the last decade."

Managing managed care. Grouping together is the answer

Working through an organization is the only way to manage in a managed care system. To be successful we need sophisticated management information systems, outstanding leadership and management, and a discretionary income distribution system. We must be willing to accept venture risk even though we will not win all the time. We must be aggressive in developing these systems. In order to survive, the successful organization will have to manage first, itself; second, the buyer of care; and third, its own image. It must also learn how to deal with the competition.