Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing fac...

Background In 2003 Germany started to replace its per-day hospital payment system by a prospective payment system based on diagnosis related groups (DRG). The primary objective of the program was to increase economic efficiency of hospital care. The introduction was accompanied by fears that quality of care could deteriorate when hospitals withhold necessary care in order to increase profits. O...

For the first 4 years of Medicare's prospective payment system (PPS), one national market basket of cost weights and price proxies has been used to update payment rates. Previous evidence for a single rate is reviewed, and more recent data are presented that show definite regional differences in input price inflation, resulting in systematic gains or losses for some regions. However, as long as...

introduction: in iran health insurance is a significant tool in healthcare costs, financing health care and equal access to health services for people. problems between hospitals and insurance organizations impose extra cost to the patient, leading to financial losses they will infringe upon the rights of patients. this study aimed to determine the issues between hospitals and basic insurance o...

This study estimates that Medicare extra payments under the hospital prospective payment system (PPS) range from about $700 per case of decubitus ulcer to $9,000 per case of postoperative sepsis in the five types of adverse events identifiable in Medicare claims. Medicare extra payment for the five types of events totals more than $300 million per year, accounting for 0.27 percent of annual Med...

In this article, data are presented on trends in the use of and program payments for inpatient short-stay hospital services to Medicare beneficiaries. The data on the services used by aged and disabled Medicare beneficiaries are presented for the years 1972 through 1988. The discussion is focused on trends in utilization and program payments resulting from the implementation of the Medicare pro...

On October 1, 2013 the reporting of diagnoses and procedures in the U.S. will transition from the clinical modification of the ninth revision of the International Classification of Diseases (ICD-9-CM) to the tenth revision (ICD-10). The impact of conversion to ICD-10 on Medicare MS-DRG payments to hospitals was estimated using 2009 Medicare data. A minimal hospital payment increase of 0.05 perc...

Prospective payment arrangements are now the main form of hospital funding in most developed countries. An essential component of such arrangements is the classification system used to differentiate patients according to their expected resource requirements. In this article we describe the evolution and structure of Healthcare Resource Groups (HRGs) in England and the way in which costs are cal...