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The Incidence of Adverse Medical Outcomes Under Prospective Payments

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  • David M. Cutler

Abstract

This paper examines the effect of prospective payment for hospital care on adverse medical outcomes. In 1983, the federal government replaced its previous cost-based reimbursement method with a prospective payment system, where reimbursement depends only On the diagnosis of the patient. Hospitals thus lost the marginal reimbursement they formally received for providing additional treatments. In addition, the average price each received changed with fixed reimbursement. This paper related each of these changes to adverse outcomes, with two conclusions. First, there is a change in the timing of deaths associated with changes in average prices. In hospitals with price declines, a greater share of deaths occur in the hospital or shortly after discharge, but by one or two years post-discharge, this difference in mortality rates disappears. Second, there is a trend increase in readmission rates caused by the elimination of marginal reimbursement. This appears to be due to accounting changes on the part of hospitals, however, rather than true changes in morbidity.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 4300.

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Date of creation: Mar 1993
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Publication status: published as Econometrica, February 1995, pp. 29-50
Handle: RePEc:nbr:nberwo:4300

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  1. Jeffrey E. Harris, 1977. "The Internal Organization of Hospitals: Some Economic Implications," Bell Journal of Economics, The RAND Corporation, The RAND Corporation, vol. 8(2), pages 467-482, Autumn.
  2. Han, Aaron & Hausman, Jerry A, 1990. "Flexible Parametric Estimation of Duration and Competing Risk Models," Journal of Applied Econometrics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 5(1), pages 1-28, January-M.
  3. Alan M. Garber & Victor R. Fuchs & James F. Silverman, 1983. "Case Mix, Costs, and Outcomes: Differences Between Faculty and Community Services in a University Hospital," NBER Working Papers 1159, National Bureau of Economic Research, Inc.
  4. Chamberlain, Gary, 1980. "Analysis of Covariance with Qualitative Data," Review of Economic Studies, Wiley Blackwell, Wiley Blackwell, vol. 47(1), pages 225-38, January.
  5. Feldstein, Martin S, 1977. "Quality Change and the Demand for Hospital Care," Econometrica, Econometric Society, Econometric Society, vol. 45(7), pages 1681-1702, October.
  6. Heckman, James & Singer, Burton, 1984. "A Method for Minimizing the Impact of Distributional Assumptions in Econometric Models for Duration Data," Econometrica, Econometric Society, Econometric Society, vol. 52(2), pages 271-320, March.
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