To the Editor.—
The SPECIAL COMMUNICATION "Hospital Use in a Fee-for-Service System" by Nobrega and co-workers (1982;247:806) failed to discuss one explanation for lower discharge and hospitalization rates in Olmsted County, Minnesota. If the incidence of specific chronic diseases in the population of Rochester and the surrounding rural community varied from the national averages, significant utilization differences would occur.A study by Zook and Moore1 of 42,880 hospital discharges in 1976 found that "the high cost 13% of patients consumed as many resources as the low cost 87%." Six diagnostic categories accounted for 66% of the most costly (high utilizing) patients. Four of these diagnoses—degenerative diseases of the heart and peripheral vessels, malignancy, renal failure (diseases of the urinary system), and alcoholism—are underrepresented by as many as 50% fewer discharges in Olmsted County when compared with the US average. The argument that this represents a true decreased incidence of disease
Kleinman JH. Hospital Use in a Fee-for-Service System. JAMA. 1982;248(3):306–307. doi:10.1001/jama.1982.03330030020006
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