Evaluating Financial Risk in the Medicare Prospective Payment System

Published Online:https://doi.org/10.1287/mnsc.45.3.316

References

  • Allen Robin, Gertler Paul. Regulation and the provision of quality to heterogeneous consumers: The case of prospective pricing of medical services. J. Regulatory Econom. (1991) 3:361–375CrossrefGoogle Scholar
  • Dada Maqbool, White William D., Stokes Houston, Kurzeja Paul. Prospective payment for psychiatric services. J. Health Politics, Policy, Law (1992) 17(3):483–508CrossrefGoogle Scholar
  • Dranove D. Rate setting by diagnosis related groups and hospital specialization. RAND J. Econom. (1987) 18(30):417–427CrossrefGoogle Scholar
  • Edwards N., Honemann D., Burley D., Navarro M. Refine-ment of the Medicare diagnosis-related groups to incorporate a measure of severity. Health Care Financing Rev. (1994) 16(2):45–64Google Scholar
  • Efron B., Tibshirani R. Bootstrap methods for standard errors, confidence intervals and other measures of statistical accuracy. Statist. Sci. (1986) 1(1):54–77CrossrefGoogle Scholar
  • Ellis R., McGuire T. Insurance principles and the design of prospective payment systems. J. Health Econom. (1988) 7CrossrefGoogle Scholar
  • Emmons D. W., Simon Carol J., Gonzalez M. L. Managed care. Evolving contractual arrangements. Socioeconomic Characteristics of Medical Practice 1996 (1996) (Center for Health Policy Research, American Medical Association, Chicago) 15–25Google Scholar
  • English J., Sharfstein S., Scherl D., Astrachan B., Muszynski I. Diagnosis-related groups and general hospital psychiatry: The APA study. Amer. J. Psychiatry (1986) 143(2):131–139CrossrefGoogle Scholar
  • Federal Register (1983) 48(171):39776Google Scholar
  • Frank R., Lave J. The psychiatric DRGs: Are they different? Medical Care (1985) 23(10):1148–1155CrossrefGoogle Scholar
  • Freiman M., McGuire T., Ellis R., Hendricks A., Mitchell J., Carter C., Harrow B., Strone A. An analysis of options for including psychiatric inpatient settings in a prospective payment system. (1988) . Final Report Contract No. NIMH-278-86-0002(BA), Health Economics Research Institute, Needham, MAGoogle Scholar
  • Goodall Colin. A simple objective method for determining a percent standard in mixed reimbursement systems. J. Health Econom. (1990) 9:253–271CrossrefGoogle Scholar
  • Health Care Finance Administration (HCFA)Report to Congress: DRG Refinement:Outliers,Severity of Illness and Intensity of Care (1987) . (Baltimore MD: Office of Research and Demonstrations, Health Care Financing Administration, September 1987) HCFA Pub. No. 03254Google Scholar
  • Jencks S., Horgan C., Goldman H., Taube C. Bringing excluded psychiatric facilities under the Medicare prospective payment system. Medical Care (1987) 25(9, supplementGoogle Scholar
  • Keeler E. B., Carter G. M., Trude S. Insurance aspects of DRG outlier payments. J. Health Econom. (1988) CrossrefGoogle Scholar
  • Kreig J. Stemming the risk of capitated contracts: What providers should consider when buying stop loss insurance. Health Care Innovations: J. Amer. Assoc. Preferred Provider Org. (1995) 5(2):12–16Google Scholar
  • Lynk W. J. The creation of economic efficiencies in hospital mergers. J. Health Econom. (1995) 14(5):507–530CrossrefGoogle Scholar
  • McGuire T., Mosakowski W., Radigan L. Designing a state-level prospective payment system for inpatient psychiatric services in Medicaid. Admin. Policy Mental Health (1990) 18(1):43–54CrossrefGoogle Scholar
  • Prospective Payment Assessment Commission (ProPAC)Medicare and the American Health Care System: Report to the Congress, June 1997 (1997) (Prospective Payment Commission, Washington, DC) Google Scholar
  • Pope Gregory C. Using hospital-specific costs to improve fairness of the perspective reimbursement system. J. Health Econom. (1990) 9:237–251CrossrefGoogle Scholar
  • Schleifer A. A theory of yardstick competition. RAND J. Econom. (1985) 16:319–327CrossrefGoogle Scholar
  • Siegel C., Jones K., Laska E., Meisner M., Lin S. A risk-based prospective payment system that integrates patient, hospital and national costs. J. Health Econom. (1992) 11(1):7–42CrossrefGoogle Scholar
  • Taube C., Lee E., Forthofer R. Diagnosis-related groups for mental disorders, alcoholism, and drug abuse: Evaluation and alternatives. Hospital and Community Psychiatry (1984) 35(5):452–455Google Scholar
  • U.S. Department of Health and Human Service (US DHHS)Report to Congress: Developing a Prospective Payment System for Excluded Hospitals (1988) (HCFA, Office of Research and Demonstrations, HCFA Pub. No. 03262) Google Scholar
INFORMS site uses cookies to store information on your computer. Some are essential to make our site work; Others help us improve the user experience. By using this site, you consent to the placement of these cookies. Please read our Privacy Statement to learn more.