...Harvey M. Sapolsky Louise B. Russell, Medicare's New Hospital Payment System: Is It Working? Washington, DC: Brookings Institution, 1989. 114 pp. Copyright © 1990 by Duke University Press 1990 932 Journal of Health Politics, Policy and Law Louise B. Russell. Medicare’sNew...

...Michael D. Rosko; Robert W. Broyles; William E. Aaronson This article evaluates the potential efficacy of implementing a prospective payment system based on case mix in the nursing home industry. The analysis of structural differences between the nursing home and hospital industries suggests that...

...Ellen M. Immergut C. David Naylor, Private Practice, Public Payment: Canadian Medicine and the Politics of Health Insurance, 1911–1966 (Kingston and Montreal: McGill-Queen's University Press, 1986), 324 pp., $35.00 cloth, $ 15.95 paper. Copyright © 1988 by Duke University Press 1988...

...Maqbool Dada; William D. White; Houston H. Stokes; Paul Kurzeja The Medicare prospective payment system (PPS) was designed to create financial incentives for providers to contain costs, but it also places them at financial risk. The system includes provisions to mitigate the risk, but, because they...

...Lee R. Chartock; Robert A. Dorwart Copyright © 1992 by Duke University Press 1992 References Christianson , J. B. , and M. S. Linehan. 1989 . Capitated Payments for Mental Health Care: The Rhode Island Programs. Community Mental Health Journal 25 : 121 -31. Cromwell , J...

.... , George J. Schieber, Martha A. Blaxall, and Jon R. Gabel. 1978 . Geographic Variation in Physicians' Fees. Journal of the American Medical Association 240 ( 13 ): 1368 -71. Caldwell , Jacques R. 1989 . Physician Payment Reform: A Practicing Physician's Perspective. Frontiers 6 ( 1...

...Thomas R. Oliver In 1985, Congress established the Physician Payment Review Commission (PPRC) to help formulate changes in the system used by Medicare to pay for physician services. The recommendations of the PPRC and subsequent legislative action led to fundamental reform. As a new type of...

...Richard W. Foster Prospective payment is distinguished from the imposition of a regulatory ceiling on hospital costs. While a regulatory ceiling could potentially be effective in controlling expenditure growth, its success depends upon the political climate. Prospective payment, as a distinct...

...Lawrence D. Brown Copyright © 1983 by the Department of Health Administration, Duke University 1983 Washington Report The Prospects for Prospective Payment Lawrence D. Brown In Washington the word is out that costs are dead. Since the Tax Equity and Fiscal...

... a differential payment justified for Medicare, Medicaid, and/or Blue Cross on the basis of differential costs? (2) Have the cost-containment efforts of the dominant payers reduced total payments to hospitals? and (3) What part of the overall savings in payments to hospitals is in the form of reduced...

...Barbara Janowitz; Sylvia Wallace; Galba Araujo; Lorena Araujo This paper examines factors associated with the cesarean birth rate, including medical condition and method of payment, in the largest maternity hospital of Fortaleza. Brazil. Data were collected on 5996 women who delivered at the...

... evidence suggests that there was cost-shifting in response to this program, which regulated payment for only Blue Cross and Medicaid patients. Structural features of this program and its successor, the New Jersey DRG program, are analyzed; and implications for the Medicare prospective payment system are...

...Richard G. Frank; Judith R. Lave Psychiatric hospitals and clinics are exempted from the Medicare prospective payment system. In this paper we examine the appropriateness of the DRG classification system for psychiatric patients and argue that, using this system as the basis of payment, two types...

... severity; however the relationship between severity and net revenue per admission was not significant. The results suggest that hospitals with a more severe case mix may not recover the full costs of providing services. Thus payment reform should include adjustments for severity of illness. Copyright...

...Robert T. Kauer; J. B. Silvers; Jill Teplensky New Medicare regulations have replaced the cost-based system of reimbursement of capital expenditures by hospitals with a fixed payment per case based on assigned diagnostic-related groups. For the first time, hospitals must pay the governmental share...

...Judith Feder; Bruce Spitz This paper analyzes the politics of hospital payment over the last decade. The authors explain how provider interests and judgments became a standard for appropriate hospital payment; the impact of that standard on hospital costs; and the political obstacles to imposing an...

...George D. Greenberg Rick Mayes and Robert A. Berenson. Medicare Prospective Payment and the Shaping of U.S. Health Care. Baltimore: Johns Hopkins University Press, 2006. 245 pp. $48.95 cloth. Duke University Press 2007 Fisher, E., and J. Wennberg. 2006 . The Care of Patients with...

...Judith Feder; William Scanlon Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients...

... aim, that is, to improve health care and population health while containing cost. These include Maryland's Global Revenue Budget model, bundled payments, and ACOs, and they highlight the extent to which this version of integration is underwritten by savings achieved by providers for the Medicare...

...Judy Feder; Alan R. Weil; Robert Berenson; Rachel Dolan; Nicole Lallemand; Emily Hayes Abstract States' role in payment as well as coverage will be subject to debate as the administration and the Congress decide how to address the Affordable Care Act (ACA) and otherwise reshape the nation's health...