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Hospital Admissions, Length of Stay, and Case-Mix Impacts of Per Case Payment: The Maryland Experience


  • David S. Salkever
  • Donald M. Steinwachs


Maryland has simultaneously operated per case - and per service hospital payment systems since 1976 with varying levels of stringency in setting per case rates. Regression analyses of this experience are used to compare the impacts of these systems on admissions, length of stay, and case-mix costliness for the period July 1, 1976 to June 30, 1981. Our results indicate a positive effect on admissions and negative effects on case-mix and length of stay for the per case payment approach relative to the per service approach. More stringent levels of per case payment are associated with stronger utilization responses.

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  • David S. Salkever & Donald M. Steinwachs, 1986. "Hospital Admissions, Length of Stay, and Case-Mix Impacts of Per Case Payment: The Maryland Experience," NBER Working Papers 2010, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:2010
    Note: HE

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    References listed on IDEAS

    1. Sloan, Frank A. & Feldman, Roger D. & Steinwald, A. Bruce, 1983. "Effects of teaching on hospital costs," Journal of Health Economics, Elsevier, vol. 2(1), pages 1-28, March.
    2. David S. Salkever & Donald M. Steinwachs & Agnes Rupp, 1985. "Hospital Cost and Efficiency Under Per Service and Per Case Payment in Maryland: A Tale of the Carrot and the Stick," NBER Working Papers 1633, National Bureau of Economic Research, Inc.
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