CMS has initiated the Nursing Home Quality Initiative (NHQI) to improve the quality of nursing home care. Central to the NHQI is the public reporting of nursing home quality measures that serve as the basis for the Initiative's communication and quality improvement program. This article provides an overview of the NHQI, focusing on the role of nursing home quality measures in achieving improvem...

UNLABELLED Diagnosis related groups (DRGs) are widely used in several countries. Their various versions aim to value the cost of hospital production. In Europe, the patient classification systems and standard weights used are usually the American originals. OBJECTIVES The objective of this study was to analyse the extent to which DRGs and DRG-weights explain patient cost variability. Differen...

Risk adjusted capitation payments attempt to pay health plans fairly for their enrollees and eliminate the incentive for health plans to attract only profitable enrollees. Diagnoses are widely used for risk adjustment, and recent theoretical papers have derived Optimal Risk Adjustment formulas that focus on plan-level rather than individual level prediction. This paper examines the selection in...

This paper explores explanations for why few private employers have adopted formal risk adjustment. The lack of data, challenges of using highly imperfect signals, and absence of market power are not compelling explanations. Alternative strategies that reduce selection problems are clearly important. The central argument is that U.S. health markets are not in equilibrium, but rather are changin...