Health Aff (24 November 2008), hlthaff.28.1.w29.
Since risk-taking, private health insurance plans were introduced into Medicare twenty-five years ago, policymakers have disagreed on these plans' fundamental purposes. Articulated objectives, which include improving quality, reducing government spending, providing additional benefits (without expanding the entitlement), increasing choices for beneficiaries, and providing benchmark competition for traditional Medicare, are plausible but sometimes conflicting. The program's history demonstrates continuous shifts in emphasis on these objectives. We enumerate the differing advantages of public and private plans in Medicare and argue that policymakers should focus their efforts on leveling the public-private playing field, thereby dealing forthrightly with the reality of growing fiscal problems. [Health Affairs 28, no. 1 (2009): w29-w40 (published online 24 November 2008; 10.1377/hlthaff.28.1.w29)] 10.1377/hlthaff.28.1.w29
Robert Berenson, Bryan Dowd
Dec 192008
Health Aff (24 November 2008), hlthaff.28.1.w29.
Posted by Robert Berenson at 3:38 pm Tagged with: 24 november, Aff, Beneficiaries, Choices, Crossroads, fiscal problems, fundamental purposes, government spending, health affairs, health insurance, health insurance plans, Health Plans, improving quality, Medicare, Medicare Plans, private health insurance, private plans, Robert Berenson, traditional medicare, twenty five years
Medicare’s DRG-weights in a European environment: the Spanish experience.
Medicare News, Syndicated
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Dec 042008
Health policy (Amsterdam, Netherlands), Vol. 51, No. 1. (February 2000), pp. 31-47.
Hospital payment systems are being changed to mixed systems, composed of case-mix categories and structure indicators. The Health Care Financing Administration's Diagnosis-Related-Groups (HCFA's DRG-weights are used in Catalonia as Prospective Payment System (PPS)-instruments for hospital inpatient reimbursement. The Catalonian and Spanish health systems, however, are very different from the US health environment. The aim of this study is to determine whether the HCFA's DRG-weights fit the special characteristics of a European environment. To do this, cost-based weights, determined from information from the cost accounting system of two public hospitals in Barcelona, are compared with Medicare-weights. A total of 35 262 discharges representing 12 794 million pesetas are analyzed. Medicare-weights do not differ globally from cost-based-weights and the adjusted correlation weighted least squares regression between the two weight-scales is 95%. There are, however, systematic deviations in six DRG-groupings. The most important deviations are concentrated in Ambulatory Surgery categories, in DRGs in which prostheses are used, and in specialties excluded from several PPSs because of extreme variables in treatment intensity. In conclusion, Medicare-weights can be used to pay hospital output in European environment but they should be adjusted to avoid systematic deviations.
F Cots, D Elvira, X Castells, E Dalmau
Hospital payment systems are being changed to mixed systems, composed of case-mix categories and structure indicators. The Health Care Financing Administration's Diagnosis-Related-Groups (HCFA's DRG-weights are used in Catalonia as Prospective Payment System (PPS)-instruments for hospital inpatient reimbursement. The Catalonian and Spanish health systems, however, are very different from the US health environment. The aim of this study is to determine whether the HCFA's DRG-weights fit the special characteristics of a European environment. To do this, cost-based weights, determined from information from the cost accounting system of two public hospitals in Barcelona, are compared with Medicare-weights. A total of 35 262 discharges representing 12 794 million pesetas are analyzed. Medicare-weights do not differ globally from cost-based-weights and the adjusted correlation weighted least squares regression between the two weight-scales is 95%. There are, however, systematic deviations in six DRG-groupings. The most important deviations are concentrated in Ambulatory Surgery categories, in DRGs in which prostheses are used, and in specialties excluded from several PPSs because of extreme variables in treatment intensity. In conclusion, Medicare-weights can be used to pay hospital output in European environment but they should be adjusted to avoid systematic deviations.
F Cots, D Elvira, X Castells, E Dalmau
Posted by F Cots at 3:27 am Tagged with: amsterdam netherlands, care financing administration, case mix, cost accounting system, Dalmau, diagnosis related groups, european environment, Experience Health, health care financing administration, health environment, hospital inpatient, least squares regression, Ppss, prospective payment system, public hospitals, spanish experience, structure indicators, systematic deviations, weight scales, weighted least squares
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