Little is known about the smaller, rural trauma centers and how they function both independently and as part of a larger trauma system. Trauma care at rural level III trauma centers in a state trauma system.Īlthough much has been written about the benefits of trauma center care, most experiences are urban with large numbers of patients.
Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. We find no evidence that care is of lower quality. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We use exogenous variation in the Medicare payment schedule to isolate the effects of market- level managed care enrollment on the quantity and quality of care delivered.
These system-level effects may depend on local health- care market structure and vary based on patient characteristics. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health- care delivery. MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH- CARE USE
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