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Evaluating Financial Risk in the Medicare Prospective Payment System

Author

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  • Maqbool Dada

    (Krannert School of Management, Purdue University, West Lafayette, Indiana 47907-1310)

  • William D. White

    (Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8034)

Abstract

The Medicare Prospective Payment System (PPS) is analogous to an insurance scheme in which financial risk is mitigated through experience rating. In addition, risk is also mitigated through reinsurance provisions. Although a provider may not want this reinsurance, participation is mandatory. We develop a framework for evaluating financial risk under the PPS. We use this framework to examine optional reinsurance as an alternative risk mitigation mechanism. We illustrate an application of optional reinsurance using data for Medicare psychiatric inpatient services. Our analysis indicates that viable schemes exist for implementing optional reinsurance as a prospective payment option.

Suggested Citation

  • Maqbool Dada & William D. White, 1999. "Evaluating Financial Risk in the Medicare Prospective Payment System," Management Science, INFORMS, vol. 45(3), pages 316-329, March.
    • Handle: RePEc:inm:ormnsc:v:45:y:1999:i:3:p:316-329
    DOI: 10.1287/mnsc.45.3.316
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    File URL: http://dx.doi.org/10.1287/mnsc.45.3.316
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    References listed on IDEAS

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    Cited by:

    1. Tinglong Dai & Mustafa Akan & Sridhar Tayur, 2017. "Imaging Room and Beyond: The Underlying Economics Behind Physicians’ Test-Ordering Behavior in Outpatient Services," Manufacturing & Service Operations Management, INFORMS, vol. 19(1), pages 99-113, February.
    2. Nicos Savva & Tolga Tezcan & Özlem Yıldız, 2019. "Can Yardstick Competition Reduce Waiting Times?," Management Science, INFORMS, vol. 65(7), pages 3196-3215, July.
    3. Tinglong Dai & Sridhar Tayur, 2020. "OM Forum—Healthcare Operations Management: A Snapshot of Emerging Research," Manufacturing & Service Operations Management, INFORMS, vol. 22(5), pages 869-887, September.

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