A doctor's decision about whether to hospitalize a patient may have less to do with financial incentives than previously thought, a study based on care provided to veterans indicates.
The study, published in the Jan. 7 New England Journal of Medicine, tracked chronically ill patients in the Department of Veterans Affairs healthcare system from 1991 to 1995. After controlling for disease severity and demographic factors, the authors found that patients in the Northeast spent up to three times longer in the hospital than those in the West.
In the private sector, this pattern has been attributed to the greater prevalence of managed care in the West, which means more incentives to minimize inpatient days.
The study's authors were surprised to find that while VA docs received the same salary regardless of their patients' utilization of care, their admitting patterns still mirrored regional norms.