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Potential responses to the Medicare pricing mechanism
Hospital & Health Services Administration
|April 10, 1986
Summary
Medicare's payment system, established by PL 98-21, may harm hospital finances and patient access to care, despite potential program benefits. This analysis examines the pricing mechanism and its consequences for healthcare providers and beneficiaries.
Area of Science:
- Health Economics
- Healthcare Policy
- Medical Services Research
Background:
- The Medicare program utilizes a patient and medical condition-based payment system.
- Public Law 98-21 introduced specific provisions impacting Medicare's pricing structure.
Purpose of the Study:
- To describe the Medicare pricing mechanism.
- To explore potential responses to the current payment system.
- To analyze the implications of the payment system on hospitals and beneficiaries.
Main Methods:
- Analysis of the Medicare pricing mechanism.
- Evaluation of the effects of Public Law 98-21.
- Assessment of financial viability and access to care.
Main Results:
- The Medicare pricing system may negatively impact hospital financial viability.
- Potential for increased inequities due to differential pricing policies.
- Risk of reduced access to in-hospital care and service utilization for beneficiaries.
Conclusions:
- While PL 98-21 may offer advantages to Medicare, the pricing system poses significant financial and access challenges.
- The current model requires careful consideration to mitigate adverse effects on healthcare providers and patient care.