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Hospital reimbursement under Medicare
The Milbank Memorial Fund Quarterly. Health and Society
|January 1, 1984
Summary
Medicare reimbursement reforms require caution. Long-term changes to the prospective payment system and diagnosis-related groups (DRGs) need evaluation before implementation, with uniform rates and teaching adjustments being critical near-term considerations.
Area of Science:
- Health economics
- Healthcare policy
- Medicare reimbursement
Background:
- Hospital care represents the largest expenditure within Medicare.
- Existing reimbursement systems are undergoing significant reforms.
- The impact of new mandates like prospective payment and DRGs is currently unevaluated.
Purpose of the Study:
- To advocate for a cautious approach to long-term reforms in Medicare's basic reimbursement system.
- To identify critical areas for near-term modifications.
- To highlight the need for evaluating the effects of prospective payment and DRGs.
Main Methods:
- Policy analysis of Medicare reimbursement structures.
- Review of current healthcare expenditure data.
- Assessment of proposed and mandated system changes.
Main Results:
- Long-term reforms to the Medicare reimbursement system necessitate careful consideration.
- The effects of prospective payment and diagnosis-related groups (DRGs) require thorough evaluation.
- Uniform national payment rates and adjustments for teaching hospitals are identified as crucial near-term issues.
Conclusions:
- A cautious strategy is essential for Medicare's long-term reimbursement reforms.
- Immediate attention should be given to refining payment rates and addressing teaching adjustments.
- Further research and evaluation are needed to understand the full impact of DRGs and prospective payment systems.