The effect of prospective payment on Medicare expenditures.
The effect of prospective payment on Medicare expenditures.
复制标题
预期付款对医疗保险支出的影响。
DOI：
--
复制
发表时间：
1989
影响因子：
158.5
通讯作者：
Carrie Manning
中科院分区：
文献类型：
--
作者：
Louise B. Russell;Carrie Manning
医疗保险的预期支付系统于1983年引入，以减缓医院护理支出的增长，这是医疗保险费用的主要部分。该系统不向医院报销病人护理的实际费用，而是按每次入院的固定费率向他们支付费用。在这项研究中，我们估计了使用预期支付的医疗保险的节省。我们分析了联邦医院保险信托基金受托人在连续10份年度报告（1979年至1988年）中公布的支出预测，该基金为医疗保险受益人支付医院账单。为了显示预期付款的影响，对这些预测进行了调整，以纠正每份报告中关于通货膨胀和入院的不同假设。我们还研究了支付门诊服务的补充医疗保险信托基金的支出趋势，以了解住院费用的节省是否被医院外服务的更高支出所抵消。我们发现，预期支付大大降低了医疗保险的住院费用。1990年医院保险信托基金的支出按1980年美元计算预计将减少120亿美元，按1990年美元计算将减少180亿美元，这比预期付款生效前不久的预期少--相当于节省约20%。相比之下，预期缴款对补充基金的影响不大。我们的结论是，预期的支付系统对医疗保险的医院支出产生了重大影响，节省的费用不会被门诊费用的增加所抵消。
Medicare's prospective payment system was introduced in 1983 to slow the growth of expenditures for hospital care, which from the bulk of Medicare costs. Instead of reimbursing hospitals for the actual costs of patient care, the system pays them at fixed rates for each admission. In this study, we estimated the savings to Medicare from the use of prospective payment. We analyzed the expenditure projections published in 10 successive annual reports (1979 to 1988) by the trustees of the federal Hospital Insurance Trust Fund, which pays hospital bills for Medicare beneficiaries. To show the effect of prospective payment, these projections were adjusted to correct for the different assumptions about inflation and admissions made in each report. We also examined trends in expenditures from the Supplementary Medical Insurance Trust Fund, which pays for outpatient services, to see whether the savings in hospital expenses were offset by higher spending for out-of-hospital services. We found that prospective payment has reduced Medicare's hospital costs substantially. Expenditures from the Hospital Insurance Trust Fund for 1990 are expected to be +12 billion less in 1980 dollars, and +18 billion in 1990 dollars, than was expected shortly before prospective payment went into effect--the equivalent of a savings of approximately 20 percent. By contrast, the effect of prospective payment on the supplementary fund has not been great. We conclude that the prospective payment system is having a major impact on Medicare's hospital expenditures and that the savings is not offset by an increase in outpatient expenditures.