Health Care Financing Policy for Hospitalized Pediatric Patients FREE

Eric Munoz, MD, MBA; Donald Chalfin, MD; Jonathan Goldstein, MPA; Rudy Lackner, MD; Katherine Mulloy, AS; Leslie Wise, MD

[+] Author Affiliations

Accepted for publication Sept 2, 1988.

Reprint requests to Research Division, Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, NY 11042 (Dr Munoz).

Am J Dis Child. 1989;143(3):312-315. doi:10.1001/archpedi.1989.02150150066019.

Text Size: A A A

Published online

Article

References

Comments

ABSTRACT

ABSTRACT | REFERENCES

• Prospective hospital payment systems using the federal Medicare DRG payment model are changing hospital reimbursement. Currently, many states have adopted diagnosis related group (DRG) prospective "all payer systems" using the federal model. All payer systems, where-by Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode, prevent cost shifting between payers. New York state has used an all payer system since Jan 1, 1988. This study simulated DRG all payer methods for a large sample (N = 16 084) of pediatric patients for a three-year period using the New York DRG all payer reimbursement system now in effect. Medicaid pediatric patients had (adjusted for DRG weight index) a longer hospital stay and greater total hospital cost compared with pediatric patients from Blue Cross and other commercial payers. Medicaid pediatric patients also had a greater severity of illness compared with patients from Blue Cross and other payers. Pediatric patients in all payment groups (ie, Medicaid, Blue Cross, and other commercial insurers) generated financial risk under the DRG all payer scheme. Medicaid pediatric patients generated the greatest financial risk, however. These data suggest that state and private payers may be under-reimbursing for the care of the hospitalized pediatric patient using the DRG prospective hospital payment scheme. Health care financing policy for pediatric patients may limit both access and quality of care.

(AJDC. 1989;143:312-315)

REFERENCES

ABSTRACT | REFERENCES

Igelhart JD: Medicare begins prospective payment for hospitals . N Engl J Med 1983;; 308:1428-1432.

1986-1987 Source Book on Health Insurance Data . Washington, DC, Health Insurance Association of America, 1987;.

Schramm CJ, Gabel J: Sounding board: Prospective payment: Some retrospective observations . N Engl J Med 1988;;318:1681-1683.

Prospective Payment Assessment Commission: Medicare Prospective Payment and the American Health Care System , report to Congress, June 1988;.

Office of Technology Assessment: Medicare's Prospective Payment System . New York, Springer Publishing Co Inc, 1986;.

Schwartz WG: The inevitable failure of current cost-containment strategies . JAMA 1987;; 257:220-224.

Munoz E, Sterman H, Cohen JR, et al: Financial risk, hospital cost, complications and comorbidities (CCs) in surgical non-CC stratified DRGs . Ann Surg 1988;;207:305-309.

Jencks SF, Dobson A: Refining case-mix adjustment . N Engl J Med 1987;;317:679-692.

Medicare program: Changes to the inpatient hospital prospective payment system and fiscal year 1989 rates . Federal Register 1988;;53( (May 27) ):19497-19686.

Muñoz E, Soldano R, Gross H, et al: Diagnosis related groups and the transfer of general surgical patients between hospitals . Arch Surg 1988;;123:68-71.

McCarthy CM: DRGs: Five years later . N Engl J Med 1988;;318:1683-1686.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal