Payment source and the cost of hospital care: evidence from a multiproduct cost function with multiple payers.
نویسندگان
چکیده
This study investigates the capacity of hospitals to vary the intensity of their services based on patients' expected sources of payment. While the concept of price discrimination by hospitals based on payer generosity ("cost-shifting") has been discussed extensively, the notion that hospitals can adjust payer-specific marginal costs to reflect differences in reimbursement policies has not been studied in depth. To examine this issue. this analysis employs a multiproduct cost function with hospital outputs defined as admissions by payment source, controlling for the distribution and severity of illness ("casemix") for each payer. Marginal costs of casemix-adjusted discharges are obtained and compared for Medicare, Medicaid, Private Payers, and a residual category that includes uncompensated care. We find that indeed, payer-specific marginal costs generally reflect payer generosity.
منابع مشابه
Unintended Consequences of Hospital Payment: The Case of Swiss Diagnosis Related Groups
Background: In 2012, Switzerland changed from retrospective to prospective hospital payment based on diagnosis related groups (DRGs), following the example of the United States, Australia, and Germany. As in these countries, the objective of this transition was to motivate hospitals to improve efficiency by making them bear financial risk to some extent.Objective:...
متن کاملEconomic Analysis of the Cost of Implants Used for Treatment of Distal Radius Fractures
Background: There are a number of different implant choices for surgical treatment of distal radius fractures, oftendetermined by surgeon preference or availability. Although no one volar plate demonstrates superior outcomes, thereare significant cost differences absorbed by hospitals and surgical centers. This purpose of this study is to characterizethe economic implications of implant selecti...
متن کاملPayer Competition and Cost Shift Ing in Health Care
This paper studies a model in which Puo payers contract with one hospital. True costs per patient are not a possible basis for payment, and contracts can only be zuritten on the basis of allocated cost. Payers choose a contract that is fully prospective or fully based on cost allocation, or n paynient scheme that zuould give some weight to eack of these two. We ckaracterize the payers‘ equilibr...
متن کاملHospitals respond to Medicare payment shortfalls by both shifting costs and cutting them, based on market concentration.
The coverage expansions planned under the Affordable Care Act are to be financed in part by slowing Medicare payment updates to hospitals, thereby reigniting the debate over whether low prices paid by public payers cause hospitals to increase prices to private insurers--a practice known as cost shifting. Recently, the Medicare Payment Advisory Commission (MedPAC) proposed an alternative explana...
متن کاملCosts of services covered by the global payment system in Tehran University of Medical Sciences
Background: In Iran, a combination of three methods of budget payment, fee for service and case-based payment (known as the global payment system) is used to reimburse the cost of hospital services. The aim of this study was to investigate the costs of 90 services of the Global Hospital Reimbursement System at Tehran University of Medical Sciences. Methods: This descriptive cross-sectional app...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Journal of health economics
دوره 15 1 شماره
صفحات -
تاریخ انتشار 1996