Working Paper: NBER ID: w2010
Authors: David S. Salkever; Donald M. Steinwachs
Abstract: 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.
Keywords: hospital payment systems; per case payment; length of stay; admissions; casemix
JEL Codes: I11; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| per case payment system (J33) | hospital admissions (I19) |
| GIR program (C88) | hospital admissions (I19) |
| GIR program (C88) | length of stay (C41) |
| GIR program (C88) | casemix (C55) |
| per case payment system (J33) | length of stay (C41) |
| per case payment system (J33) | casemix (C55) |
| hospital admissions (I19) | perverse utilization responses (D11) |