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PubMed1983

Utilization of hospital services: the roles of teaching, case mix, and reimbursement.

This study examined the role of hospital teaching affiliation, third-party payer mix, physician compensation, and case mix on the utilization of inpatient services. Using multivariate analysis with five different utilization measures, we found that: 1) the level of teaching activity and commitment to teaching had no significant effect on the scope of inpatient service utilization; 2) self-pay patients were low utilizers whereas Medicaid patients were high utilizers; 3) inpatient utilization appeared to be lower when physicians were compensated on a salaried basis; and 4) case mix had a significant impact on inpatient utilization.

Clinical Laboratory Techniques↗
PubMed1984

Hospital reimbursement under Medicare.

Although hospital care forms the largest expenditure under Medicare, long-term reforms in the basic reimbursement system should be approached cautiously. The effects of newly mandated changes--prospective payment and DRGs--have yet to be evaluated, but some modifications should be considered for the near term. Uniform, national payment rates and adjustments for teaching are especially critical areas.

Cost Control↗
PubMed1984

Selected results from an evaluation of the New Jersey Diagnosis-Related Group System.

After briefly describing the New Jersey Diagnosis-Related Group (DRG) system and comparing/contrasting it with the Medicare prospective payment plan, selected findings from an evaluation of the New Jersey DRG experience are presented. The discussion highlights the system's effect on ways in which hospitals are organized and managed, and its preliminary economic and financial impact.

Cost Control↗
PubMed1998

Merging HMOs into an all-payer system: a model to pursue?

An almost unending debate over the future shape of America's health care system increasingly focuses on the continuum between managed competition and government regulations, and the question: What is right for the United States? The Maryland all-payer, rate setting system for its 50 hospitals, where over a third of the state's population is enrolled in managed care plans, is used as an example of relatively successful blending of competitive and regulatory strategies. This article concludes with the theme that given America's penchant for compromise, competitive and regulatory approaches can coexist in a pluralistic health system that constrains the use of services and costs, and enhances access and the quality of patient care.

Economic Competition↗
PubMedDate not supplied

[Analytic study of the hospital self inspection results with the medical insurance inpatient fee from the viewpoint of the hospital management--based on one university hospital pre-discharge inspection].

The purposes of this study were to evaluate the results of the hospital self inspection with the medical insurance and to offer basic materials to the medical insurance inspection and the education of medical insurance. The study was undertaken with 4,730 cases among the total 13,810 medical insurance in patients from Jan. 1990 to Dec. 1990 at one university hospital in Pusan. The major contents of the inspection were the omission of diagnosis and medical fee, curtailment, application mistake, the rates of inclusion, subtraction and total accumulation. The data were collected using patients charts and bills. The results of the paper analysis were as follows. 1. From the pre-discharge hospital self inspection, major omission were treatment and material fee but medication fee were moderately high and high curtailment was operation fee. 2. Decreasing order of operation fee adjustment were digestive (22.4%) muscular (22%) and neuro system operation (21.4%). Majority of the medication fee adjustments were injection form of medication (95.7%). 50% of the treatment fee adjustments were composed of injection fee (27.9%) and dressing or post-operative dressing fee (22.3%). 74.7% of material costs were composed of oxygen (30.6%), blood and the blood composed materials (44.1%). 3. Pre-discharge inspection showed 6% adjustment rate, 4.3% addition and 2.1% curtailment rate. Most of the adjustment were omission (66.1%). 4. Omission were divided by event omission (92.6%) and application mistake (7.4%). The decreasing order of omission fee were operation (21.84%), treatment (18.71%) diagnosis (18.68%), medication (14.53%) and material costs (10.84%). So operation and treatment part were the major part of the total omission fee (40.55%). 5. The average omission of diagnosis were 1,800 per month.

Fees, Medical↗