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New Evidence on Medicare's Prospective Payment System: A Survival Analysis based on the NHANES I Epidemiologic Followup Study

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Author Info

  • Xufeng Qian

    ()
    (Moody's)

  • Louise Russell

    ()
    (Rutgers/Economics and Institute for Health)

  • Elmira Valiyeva

    ()
    (Rutgers)

  • Jane Miller

    ()
    (Rutgers/Bloustein School and Institute for Health)

Abstract

Medicare’s prospective payment system (PPS), introduced in 1983, pays hospitals a fixed price for each stay rather than reimbursing costs. Previous studies evaluated its first few years using endogenous measures to control for heterogeneity in patients’ health. We examine PPS over a full decade using competing risks Cox survival models and a national longitudinal survey with independent information on patients’ health. New findings include: risk of death in hospital increased; risk of discharge to a nursing home continued to increase as PPS matured; and risk of nursing home admission from the community following hospital discharge rose. HMOs may have contributed to these outcomes.

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Bibliographic Info

Paper provided by Rutgers University, Department of Economics in its series Departmental Working Papers with number 200506.

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Date of creation: 19 Jul 2005
Date of revision:
Handle: RePEc:rut:rutres:200506

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Keywords: Medicare;

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References

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  1. Gabriel A. Picone & Frank A. Sloan & Shin-Yi Chou & Donald H. Taylor, 2003. "Does Higher Hospital Cost Imply Higher Quality of Care?," The Review of Economics and Statistics, MIT Press, vol. 85(1), pages 51-62, February.
  2. Cutler, D.M., 1992. "The Incidence of Adverse Medical Outcome Under Prospective Payment," Harvard Institute of Economic Research Working Papers 1603, Harvard - Institute of Economic Research.
  3. Newhouse, Joseph P. & Byrne, Daniel J., 1988. "Did Medicare's Prospective Payment System cause length of stay to fall?," Journal of Health Economics, Elsevier, vol. 7(4), pages 413-416, December.
  4. Daniel P. Kessler & Mark B. McClellan, 2000. "Is Hospital Competition Socially Wasteful?," The Quarterly Journal of Economics, MIT Press, vol. 115(2), pages 577-615, May.
  5. Nazmi Sari, 2002. "Do competition and managed care improve quality?," Health Economics, John Wiley & Sons, Ltd., vol. 11(7), pages 571-584.
  6. Shen, Yu-Chu, 2003. "The effect of financial pressure on the quality of care in hospitals," Journal of Health Economics, Elsevier, vol. 22(2), pages 243-269, March.
  7. 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 185-91, February.
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Cited by:
  1. Afsaneh Bjorvatn, 2013. "Hospital readmission among elderly patients," The European Journal of Health Economics, Springer, vol. 14(5), pages 809-820, October.

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