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Do Capitated Hospital Budgets Influence Rates Of Select Procedures?
Darya Fadavi, BS, Oluseyi Aliu, MD, MS.
Johns Hopkins School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore, MD, USA.

PURPOSE: In January 2014, the state of Maryland instituted the Global Budget Revenue (GBR) hospital funding policy. This one-in-the-nation hospital funding policy caps hospital spending for all hospitals in Maryland. Historically, there have been concerns from previous experiences with global budgets in other advanced western economies, that cost savings are realized at the expense of providing services. In this study, we sought to examine the effect of Maryland's GBR on the rates of surgery for Hidradenitis Suppurativa, a progressive inflammatory disease of apocrine sweat glands that disproportionately affects minority populations.
METHODS: We used data from the Maryland State Ambulatory Surgery Database from 2009 - 2016. We examined the association between the GBR implementation and rates of surgical treatment for hidradenitis. Using adjusted Segmented Regression Analysis with a Time Series model, we estimated the influence of the GBR policy on the change in rates of surgical treatment for hidradenitis over the study period. All statistical analyses were completed using Stata v.13 (StataCorp, College Station, TX).
RESULTS: The mean age was 37.2 years (SD 0.11), 61.7% of the patients were black, 96.8% of patients were female, and 79.4% had greater than 1 chronic condition. Female patients had higher odds of surgical treatment (OR 1.31 (95% CI:1.17, 1.47)) as did patients with greater than 1 chronic condition (OR 2.26 (95% CI:1.86 - 2.76)). The analytical model showed a 0.7% per quarter decline in surgical Hidradenitis Suppurativa treatment after GBR implementation (-0.7(-0.011, -0.003).
CONCLUSION: Patients in Maryland had a decreased likelihood of receiving a surgical hidradenitis procedure for each subsequent quarter after implementation of capitated hospital spending. These findings raise questions about the impact of contractionary hospital spending policy on provision of services to vulnerable populations, which can ultimately lead to differences in health outcomes.


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