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Economics of managed care in spinal cord injury. Arch Phys Med Rehabil 1999 Nov;80(11):1441-9 PMID: 10569439

Pubmed ID



OBJECTIVE: To determine and describe trends in economic variables related to the care of individuals with spinal cord injury (SCI) and significant changes in these trends coincident with major developments in medical care cost control.

DATA SOURCES: Data from the National Spinal Cord Injury Statistical Center (NSCISC) database were used to review the economic trends in SCI management from 1973 to 1998 and their relation to managed care and other health care cost-containment measures. A panel of SCI health care specialists was interviewed to determine the appropriate data variables to be reviewed. The Shepherd Center Care Health Management Program, Atlanta, GA, is presented as an example of a fiscally successful managed care program for patients with SCI.

DATA EXTRACTION: Data from the NSCISC database for the years studied were extracted and converted to a form suitable for analysis by means of the statistical software SAS.

DATA SYNTHESIS: Statistical techniques included multiple regression analysis, logistic regression analysis, and model selection methods.

CONCLUSIONS: Trends in economic variables, in the care of individuals with SCI show changes coincident with the introduction of Diagnostic Related Groups (DRGs) and managed care as models for provider reimbursement. Significant changes occurred in acute care charges, rehabilitation charges, length of stay, rehospitalization 1 year postinjury, time from injury to admission to a Model System, and discharges to a nursing home.

Author List

Fiedler IG, Laud PW, Maiman DJ, Apple DF


Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Dennis J. Maiman MD, PhD Professor in the Neurosurgery department at Medical College of Wisconsin


2-s2.0-0032750244   50 Citations

MESH terms used to index this publication - Major topics in bold

Cost Control
Databases, Factual
Fees, Medical
Length of Stay
Managed Care Programs
Rehabilitation Centers
Spinal Cord Injuries
jenkins-FCD Prod-353 9ccd8489072cb19f5b9f808bb23ed672c582f41e