Article

Since 1993, the numbers of hip and knee replacements in the United States have
increased 2-fold to 3-fold while lengths of stay in acute care have decreased by
about half, leading to a significant growth in the use of postacute
rehabilitative care for patients with a joint replacement. To document these
trends, this article uses secondary analysis of acute hospital discharge survey
data and evaluates projections to 2030. This article uses a market approach to
identify 3 sets of factors that influence the use of joint replacements: (1)
increasing patient demand, (2) increasing supply of practitioners, and (3) the
role of fiscal intermediaries. The article reviews underlying epidemiologic
trends, growing numbers of orthopedic surgeons performing the procedure,
technologic innovations, changing indications for the procedure, changing payer
mix, and the effects of payer attempts to contain joint replacement costs. An
unintended effect of Medicare payment policy has been to shift costs from acute
care to downstream postacute care. Medicare and private health plan reimbursement
policies need to take into account this broader perspective and not examine joint
replacement care and payment in isolated care settings. Future research and
health policy needs to consider the interdependent features of the health care
system by linking changes in postacute care with upstream changes both in society
at large and in the organization, delivery, and financing of acute care
associated with joint replacement.

Langue : ANGLAIS