Subject(s)
Cesarean Section/statistics & numerical data , Cesarean Section/trends , Female , Forecasting , Humans , North Carolina , PregnancyABSTRACT
A natural movement away from traditional first-dollar health care benefits to coverage with cost-sharing features was studied among employer groups covered by Blue Cross and Blue Shield of North Carolina. The groups choosing the new benefits were atypical: they had a record of high rates of hospitalization. The new benefits were successful in shifting part of the financial burden away from the employer and, additionally, the groups collectively experienced a decline in inpatient utilization in excess of the decrease noted among controls. Despite the overall decline in utilization, their days/1000 remained in excess of the control groups in the year following the benefit change. Not every group experienced a utilization decline. Participants in counties with traditionally low levels of utilization did not experience a further decline.
Subject(s)
Blue Cross Blue Shield Insurance Plans , Deductibles and Coinsurance , Hospitalization/economics , Insurance, Hospitalization , Insurance, Physician Services , Female , Hospitalization/trends , Hospitals/statistics & numerical data , Humans , Male , North CarolinaABSTRACT
The construction of an episode-of-care file based on utilization data from the insurance claims system of Blue Cross and Blue Shield of North Carolina was undertaken for its subscribers and Medicare beneficiaries, a data base that includes 60% of the hospital days in North Carolina. The conversion was accomplished without interfering with the integrity of the accounting system, and the resulting file provides essential data for management decisions and epidemiological research. Among the uses to which the information in the file can be put are the promotion of ambulatory surgery, the redesign of group insurance benefits by employers, and the support of statewide health planning programs.
