Do unprofitable patients face access problems?

Area of Science:

• Healthcare Economics
• Health Services Research
• Hospital Management

Background:

• The prospective payment system (PPS) was implemented to control healthcare costs.
• Concerns exist regarding potential access problems for unprofitable patient groups under PPS.
• Diagnosis-related groups (DRGs) are used to classify patient cases for payment.

Purpose of the Study:

• To evaluate if the PPS implementation created access barriers for patients likely to be unprofitable.
• To investigate patient placement and transfer patterns post-PPS implementation.

Main Methods:

• Analysis of patient data following the implementation of the prospective payment system.
• Comparison of transfer rates and hospital destinations for patients in profitable versus unprofitable DRGs.
• Examination of outlier patient placement in 'last resort' hospitals.

Main Results:

• Patients in typically unprofitable DRGs were not more likely to be transferred after PPS implementation.
• A higher proportion of unprofitable DRG patients were observed in 'last resort' hospitals.
• Outlier patients did not show an increased likelihood of being in 'last resort' facilities.

Conclusions:

• While not definitively a serious problem, the increased concentration of unprofitable patients in 'last resort' hospitals warrants further monitoring.
• The PPS may be indirectly affecting patient access by concentrating vulnerable populations in specific types of facilities.
• Continued scrutiny of patient access issues under the prospective payment system is recommended.