Organizational and Policy Responses of Flint Area Hospitals to the Medicare Prospective Payment System

diagnosis related groups (DRGs);Medicare;prospective payment plan;Public Administration

McKellar, John David, Jr.Flint ;

University of Michigan

关键词: diagnosis related groups (DRGs);    Medicare;    prospective payment plan;    Public Administration;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/143476/McKellar.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

In 1983, Congress approved a Medicare prospective payment plan for most inpatient hospital services which is widely regarded as the most significant change in the government health insurance program since its beginning. The radically altered reimbursement incentives inherent in DRG-based prospective payment produce different contingencies and constraints that, in turn, require dramatically different organizational and policy responses by hospitals. This paper describes a study designed to determine the extent to which local, Flint area hospitals are choosing the predicted, advised responses, what institutional variables are operating to influence those choices, and whether there is evidence that government policy intent will be achieved. Interviews conducted with senior administrators at five sample hospitals confirmed that medical and financial information systems are being enhanced and integrated, outpatient services are expanding, hospitals are becoming more diversified in the types of services they provide, and vertically integrated healthcare provider systems are developing in response to the prospective pricing plan. Contrary to expectation, and legislative intent, little evidence was found of service (DRG) specialization by hospitals or greater physician administrative involvement. Nor are hospitals restructuring internally to a product-line, matrix management approach in response to the Medicare reimbursement policy change.