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Medicare's Prospective Payment System: The Victim of Aggregation Bias?

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  • Feigenbaum, Susan
  • Anderson, Gerard
  • Lave, Judith R

Abstract

Since 1979, the Medicare program has relied upon hospital cost function parameter estimates to develop a hospital-level and, subsequently, patient-level reimbursement system. This paper demonstrates that the resulting payment adjusters are derived from biased estimates of the impact of patient and hospital-specific characteristics on individual treatment cost. Because hospitals appear to differ in their treatment cost functions, aggregation bias is present in such hospital cost models. Given this misspecification of the aggregate cost relationship, policymakers may be wise to consider patient-level cost analyses in their design of a patient-based prospective payment system. Copyright 1992 by MIT Press.

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  • Feigenbaum, Susan & Anderson, Gerard & Lave, Judith R, 1992. "Medicare's Prospective Payment System: The Victim of Aggregation Bias?," The Review of Economics and Statistics, MIT Press, vol. 74(1), pages 185-191, February.
  • Handle: RePEc:tpr:restat:v:74:y:1992:i:1:p:185-91
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    Cited by:

    1. Coyte, Peter C. & Young, Wendy & Croxford, Ruth, 2000. "Costs and outcomes associated with alternative discharge strategies following joint replacement surgery: analysis of an observational study using a propensity score," Journal of Health Economics, Elsevier, vol. 19(6), pages 907-929, November.
    2. Xufeng Qian & Louise Russell & Elmira Valiyeva & Jane Miller, 2005. "New Evidence on Medicare's Prospective Payment System: A Survival Analysis based on the NHANES I Epidemiologic Followup Study," Departmental Working Papers 200506, Rutgers University, Department of Economics.

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