ABSTRACT
Systematic variation in patient resource use can be a significant problem for a system based on diagnosis-related groups (DRG's) if this variation is not evenly distributed across hospitals. If certain hospitals routinely treat patients who require more services than average under DRG's, the long-run financial viability of these hospitals will be threatened. In this study, the authors examine whether patients who are admitted on an emergency or urgent basis represent an identifiable group of patients whose costs are systematically higher than those of electively admitted patients, controlling for DRG. Alternative approaches for incorporating admission status into a DRG payment system are developed and tested.
Subject(s)
Diagnosis-Related Groups/statistics & numerical data , Economics, Hospital/statistics & numerical data , Emergencies/economics , Medicare/statistics & numerical data , Patient Admission/economics , Prospective Payment System/standards , Costs and Cost Analysis/statistics & numerical data , Data Collection , Models, Statistical , New Jersey , Regression AnalysisABSTRACT
State policies, with respect to the operation of Medicaid programs and the regulation of private health insurance, affect who gets what care, how much is spent, and who ultimately pays. A RAND Corporation study was used to assess States and the District of Columbia in terms of the effects of their Medicaid and health insurance regulations on people with acquired immunodeficiency syndrome and other human immunodeficiency virus-related illnesses. State characteristics are used to explain the individual State policy rankings.
