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window.loswp.showSignupCaptcha = false window.loswp.willEdgeCache = false; window.loswp.work = {"work":{"id":26852912,"created_at":"2016-07-09T00:57:45.169-07:00","from_world_paper_id":155304767,"updated_at":"2024-11-27T16:30:10.919-08:00","_data":{"ai_title_tag":"Hospital Costs and Efficiency: Maryland's Payment Incentives","grobid_abstract":"The simultaneous operation of per case and per service payment systems in Maryland, and the varying levels of stringency used in setting per case rates allows comparison of effects of differing incentive structures on hospital costs. This paper presents such a cothparison with 1977-1981 data. Cost per case and total cost regressions show evidence of lower costs only when per case payment limits are very stringent. Positive net revenue incentives appear insufficient to induce reductions in length of stay and in ancillary services use. Our results suggest these changes in medical practice patterns are more likely under the threat of financial losses.","publication_name":"Inquiry: a journal of medical care organization, provision and financing","grobid_abstract_attachment_id":"47123729"},"document_type":"paper","pre_hit_view_count_baseline":null,"quality":"high","language":"en","title":"Hospital cos and efficiency under per service and per case payment in Maryland: A Tale of the Carrot and the Stick","broadcastable":true,"draft":null,"has_indexable_attachment":true,"indexable":true}}["work"]; window.loswp.workCoauthors = [6036887]; window.loswp.locale = "en"; window.loswp.countryCode = "SG"; window.loswp.cwvAbTestBucket = ""; window.loswp.designVariant = "ds_vanilla"; window.loswp.fullPageMobileSutdModalVariant = "control"; window.loswp.useOptimizedScribd4genScript = false; window.loginModal = {}; window.loginModal.appleClientId = 'edu.academia.applesignon'; window.userInChina = "false";</script><script defer="" src="https://accounts.google.com/gsi/client"></script><div class="ds-loswp-container"><div class="ds-work-card--grid-container"><div class="ds-work-card--container js-loswp-work-card"><div class="ds-work-card--cover"><div class="ds-work-cover--wrapper"><div class="ds-work-cover--container"><button class="ds-work-cover--clickable js-swp-download-button" data-signup-modal="{"location":"swp-splash-paper-cover","attachmentId":47123729,"attachmentType":"pdf"}"><img alt="First page of “Hospital cos and efficiency under per service and per case payment in Maryland: A Tale of the Carrot and the Stick”" class="ds-work-cover--cover-thumbnail" src="https://0.academia-photos.com/attachment_thumbnails/47123729/mini_magick20190207-27009-kngq7e.png?1549592581" /><img alt="PDF Icon" class="ds-work-cover--file-icon" src="//a.academia-assets.com/images/single_work_splash/adobe_icon.svg" /><div class="ds-work-cover--hover-container"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span><p>Download Free PDF</p></div><div class="ds-work-cover--ribbon-container">Download Free PDF</div><div class="ds-work-cover--ribbon-triangle"></div></button></div></div></div><div class="ds-work-card--work-information"><h1 class="ds-work-card--work-title">Hospital cos and efficiency under per service and per case payment in Maryland: A Tale of the Carrot and the Stick</h1><div class="ds-work-card--work-authors ds-work-card--detail"><a class="ds-work-card--author js-wsj-grid-card-author ds2-5-body-md ds2-5-body-link" data-author-id="6036887" href="https://umbc.academia.edu/DavidSalkever"><img alt="Profile image of David Salkever" class="ds-work-card--author-avatar" src="//a.academia-assets.com/images/s65_no_pic.png" />David Salkever</a></div><div class="ds-work-card--detail"><p class="ds-work-card--detail ds2-5-body-sm">Inquiry: a journal of medical care organization, provision and financing</p><div class="ds-work-card--work-metadata"><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">visibility</span><p class="ds2-5-body-sm" id="work-metadata-view-count">…</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">description</span><p class="ds2-5-body-sm">36 pages</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">link</span><p class="ds2-5-body-sm">1 file</p></div></div><script>(async () => { const workId = 26852912; 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This paper presents such a cothparison with 1977-1981 data. Cost per case and total cost regressions show evidence of lower costs only when per case payment limits are very stringent. Positive net revenue incentives appear insufficient to induce reductions in length of stay and in ancillary services use. Our results suggest these changes in medical practice patterns are more likely under the threat of financial losses.</p><div class="ds-work-card--button-container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--work-card","attachmentId":47123729,"attachmentType":"pdf","workUrl":"https://www.academia.edu/26852912/Hospital_cos_and_efficiency_under_per_service_and_per_case_payment_in_Maryland_A_Tale_of_the_Carrot_and_the_Stick"}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--work-card","attachmentId":47123729,"attachmentType":"pdf","workUrl":"https://www.academia.edu/26852912/Hospital_cos_and_efficiency_under_per_service_and_per_case_payment_in_Maryland_A_Tale_of_the_Carrot_and_the_Stick"}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div><div class="ds-signup-banner-trigger-container"><div class="ds-signup-banner-trigger ds-signup-banner-trigger-control"></div></div><div class="ds-signup-banner ds-signup-banner-control"><div id="ds-signup-banner-close-button"><button class="ds2-5-button ds2-5-button--secondary ds2-5-button--inverse"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">close</span></button></div><div class="ds-signup-banner-ctas"><img src="//a.academia-assets.com/images/academia-logo-capital-white.svg" /><h4 class="ds2-5-heading-serif-sm">Sign up for access to the world's latest research</h4><button class="ds2-5-button ds2-5-button--inverse ds2-5-button--full-width js-swp-download-button" data-signup-modal="{"location":"signup-banner"}">Sign up for free<span class="material-symbols-outlined" style="font-size: 20px" translate="no">arrow_forward</span></button></div><div class="ds-signup-banner-divider"></div><div class="ds-signup-banner-reasons"><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Get notified about relevant papers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Save papers to use in your research</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Join the discussion with peers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Track your impact</span></div></div></div><script>(() => { // Set up signup banner show/hide behavior: // 1. 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This paper presents such a cothparison with 1977-1981 data. Cost per case and total cost regressions show evidence of lower costs only when per case payment limits are very stringent. Positive net revenue incentives appear insufficient to induce reductions in length of stay and in ancillary services use. Our results suggest these changes in medical practice patterns are more likely under the threat of financial losses.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Hospital Cost and Efficiency Under Per Service and Per Case Payment in Maryland: A Tale of the Carrot and the Stick","attachmentId":47123703,"attachmentType":"pdf","work_url":"https://www.academia.edu/26852927/Hospital_Cost_and_Efficiency_Under_Per_Service_and_Per_Case_Payment_in_Maryland_A_Tale_of_the_Carrot_and_the_Stick","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/26852927/Hospital_Cost_and_Efficiency_Under_Per_Service_and_Per_Case_Payment_in_Maryland_A_Tale_of_the_Carrot_and_the_Stick"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="1" data-entity-id="26852914" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/26852914/Hospital_Admissions_Length_of_Stay_and_Case_Mix_Impacts_of_Per_Case_Payment_The_Maryland_Experience">Hospital Admissions, Length of Stay, and Case-Mix Impacts of Per Case Payment: The Maryland Experience</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="6036887" href="https://umbc.academia.edu/DavidSalkever">David Salkever</a></div><p class="ds-related-work--abstract ds2-5-body-sm">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.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Hospital Admissions, Length of Stay, and Case-Mix Impacts of Per Case Payment: The Maryland Experience","attachmentId":47123734,"attachmentType":"pdf","work_url":"https://www.academia.edu/26852914/Hospital_Admissions_Length_of_Stay_and_Case_Mix_Impacts_of_Per_Case_Payment_The_Maryland_Experience","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/26852914/Hospital_Admissions_Length_of_Stay_and_Case_Mix_Impacts_of_Per_Case_Payment_The_Maryland_Experience"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="2" data-entity-id="54929292" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/54929292/Hospital_profits_The_effects_of_reimbursement_policies">Hospital `profits' : The effects of reimbursement policies</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="22911433" href="https://upenn.academia.edu/PatriciaDanzon">Patricia Danzon</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of Health Economics, 1982</p><p class="ds-related-work--abstract ds2-5-body-sm">This paper provides a theoretical and empirical analysis of the eff't of mst-based reimbursement (CBR) on hospital costs and charges. It takes issue with previous analyses which have treated CBR as paying economic costs plus a markup , and have concluded that the markup is too small to significantly distort hospital decision-making. The basic thesis here is that if reimbursement is based on costs, accounting costs become a price to cost-paying patients, and will be optlmlzed to maxim& revenue. A hospital serving both cost and charge-paying (private) patients can set two price schedules. Accounting profits (ratio of charges to costs) are not a measure of economic profit but of relative prices to these two groups of patients. In the absence of constraints from regulation or patient co-payment, the optimum level of accounting costs would be infinite. In practice, the Medicare reimbursement formula links allowable costs to charges received from charge-paying patients. This formula creates incentives for the hospital to raise charges above the single-prim profit-maxim& g monopoly level. This inflationary effect of the Medicare formula does not presuppose that Medicare pays less than full cost. The emplrlcal analysis of hospital laboratory costs and charges generally supports the predictions; for other departments, the conclusions are consistent but more tentative because of data limitations. Overall, evidence suggests minimal cross-subsidy between cost and chargepaying patients. Comparisons of cost and charge levels in for-profit, voluntary non-profit and government hospitals are presented, but it is emphasized that inferences about relative efliciency and profitabiity cannot be drawn from accounting data, given the inantives created by CBR.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Hospital `profits' : The effects of reimbursement policies","attachmentId":71050387,"attachmentType":"pdf","work_url":"https://www.academia.edu/54929292/Hospital_profits_The_effects_of_reimbursement_policies","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/54929292/Hospital_profits_The_effects_of_reimbursement_policies"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="3" data-entity-id="15816132" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/15816132/Managing_care_incentives_and_information_an_exploratory_look_inside_the_black_box_of_hospital_efficiency">Managing care, incentives, and information: an exploratory look inside the" black box" of hospital efficiency</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="35004148" href="https://independent.academia.edu/DouglasConrad">Douglas Conrad</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Health Services …, 1996</p><p class="ds-related-work--abstract ds2-5-body-sm">Objective. We sought to estimate the impact of individual dimensions of hospitals' managed care strategies on the cost per hospital discharge. Study Setting/Data Sources. Thirty-seven member hospitals ofseven health systems in the Pacific, Rocky Mountain, and Southwest regions of the United States were studied. Study Design. Separate cross-sectional regression analyses of 21,135 inpatient discharges were performed in 1991 and 23,262 discharges in 1992. The multivariate model was estimated with hospital cost per discharge as the dependentvariable. Model robustness was checked by comparing regression results at the individual discharge level with those at the level of the hospital/clinical condition pair. Data Collection/Extraction Methods. Information on hospitals' managed care strategies was provided by mail and phone survey of key informants in 1991 and 1992. Other hospital characteristics were collected from AHA Annual Survey data, and discharge data from hospital abstracting systems. Principal Findings. The pooled discharge analysis indicated three dimensions of hospital managed care strategy that consistently related to lower costs per hospital discharge: the proportion of hospital revenues derived from per case or capitation payment, the hospital's mechanisms for sharing information on resource consumption with clinicians, and the use of formalized, systematic care coordination mechanisms. Conclusions. Three strategies appear to hold promise for enhancing the efficiency of inpatient resource use: (1) "fixed price" hospital payment incentives, (2) hospital approaches to sharing resource use information with clinicians, and (3) the application offormal care management mechanisms for specific clinical conditions. The health care system of the United States is undergoing major transformation, both in its delivery and its financing structures. This fundamental change is being driven by a variety ofsocial and economic forces-the growing sensitivity to high and rising health care costs by organized purchasers, the need to ensure better access to affordable care for the substantial uninsured population, and the results of a variety of "natural experiments" suggesting that better models ofhealth care financing and delivery are available . The concept of "managed care" is central to the system changes now under way, and there is some evidence that certain forms of managed care can reduce health care costs without compromising the quality of care .</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Managing care, incentives, and information: an exploratory look inside the\" black box\" of hospital efficiency","attachmentId":42876248,"attachmentType":"pdf","work_url":"https://www.academia.edu/15816132/Managing_care_incentives_and_information_an_exploratory_look_inside_the_black_box_of_hospital_efficiency","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/15816132/Managing_care_incentives_and_information_an_exploratory_look_inside_the_black_box_of_hospital_efficiency"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="4" data-entity-id="86375958" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/86375958/The_Effects_of_Government_Reimbursement_on_Hospital_Costs_Some_Empirical_Evidence_from_Washington_State">The Effects of Government Reimbursement on Hospital Costs: Some Empirical Evidence from Washington State</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="44385407" href="https://independent.academia.edu/DFriesner">Daniel Friesner</a></div><p class="ds-related-work--abstract ds2-5-body-sm">We use a panel of hospitals from Washington state to examine the impact of government reimbursement on a provider's costs. We find that providers change their relative patient mix when Medicare and Medicaid lower reimbursement rates. On a percentage change basis, the magnitudes of these changes are small; however, the overall economic impacts are quite large. Additionally, our findings indicate that a number of other factors significantly influence a provider's costs, including patient demographics, initial illness severity and input market conditions facing the firm. We thank two anonymous reviewers for their helpful comments. We also thank William Greene for valuable econometric advice when making revisions to this manuscript. Remaining errors are our own.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"The Effects of Government Reimbursement on Hospital Costs: Some Empirical Evidence from Washington State","attachmentId":90842216,"attachmentType":"pdf","work_url":"https://www.academia.edu/86375958/The_Effects_of_Government_Reimbursement_on_Hospital_Costs_Some_Empirical_Evidence_from_Washington_State","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/86375958/The_Effects_of_Government_Reimbursement_on_Hospital_Costs_Some_Empirical_Evidence_from_Washington_State"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="5" data-entity-id="81412376" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/81412376/Hospital_Pay_For_Performance_Programs_In_Maryland_Produced_Strong_Results_Including_Reduced_Hospital_Acquired_Conditions">Hospital Pay-For-Performance Programs In Maryland Produced Strong Results, Including Reduced Hospital-Acquired Conditions</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="134082283" href="https://independent.academia.edu/DianneFeeney">Dianne Feeney</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Health Affairs, 2012</p><p class="ds-related-work--abstract ds2-5-body-sm">Over the past decade Medicare has put in place several pay-forperformance programs for hospitals, including one that stopped paying hospitals for treating hospital-acquired conditions and the Hospital Value-Based Purchasing Program that went into effect in October 2012. In this article we describe how the State of Maryland crafted two pay-forperformance programs applicable to all hospitals and payers-a Quality-Based Reimbursement Program similar to Medicare's value-based purchasing program and a separate program that compared hospitals' risk-adjusted relative performance on a broad array of hospital-acquired conditions. In the first program, all clinical process-of-care measures improved from 2007 to 2010, and variations among hospitals decreased substantially. For example, the statewide average rate of provision of influenza vaccines to patients with pneumonia increased by 20.5 percentage points, from 71.5 percent in 2007 to 92.0 percent in 2010. As a result of the second program, hospital-acquired conditions in the state declined by 15.26 percent over two years, with estimated cost savings of $110.9 million over that period. Extrapolating these results, the Medicare fee-for-service program nationally would have saved $1.3 billion over two years by implementing a similar hospital-acquired conditions program. The state programs used strong and consistent financial incentives to motivate hospitals' efforts to improve quality. This experience demonstrates that successful state experimentation can inform and influence federal policy and efforts to coordinate payment strategies in other states.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Hospital Pay-For-Performance Programs In Maryland Produced Strong Results, Including Reduced Hospital-Acquired Conditions","attachmentId":87463815,"attachmentType":"pdf","work_url":"https://www.academia.edu/81412376/Hospital_Pay_For_Performance_Programs_In_Maryland_Produced_Strong_Results_Including_Reduced_Hospital_Acquired_Conditions","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/81412376/Hospital_Pay_For_Performance_Programs_In_Maryland_Produced_Strong_Results_Including_Reduced_Hospital_Acquired_Conditions"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="6" data-entity-id="24926381" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/24926381/Profit_incentives_and_the_hospital_industry_Are_we_expecting_too_much">Profit incentives and the hospital industry: Are we expecting too much?</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="48051604" href="https://independent.academia.edu/RegisterCharles">Charles Register</a><span>, </span><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="48293745" href="https://independent.academia.edu/DBivin">David Bivin</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Health Services Research</p><p class="ds-related-work--abstract ds2-5-body-sm">In the recent past, a great deal of faith has been placed in the idea that the performance of the hospital industry could be improved significantly by relying more heavily on profit incentives. This article considers the effect of profit incentives on hospital behavior and finds that the existence of profit incentives has not led the for-profit hospitals in the sample to behave in significantly different economic fashions than the nonprofits.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Profit incentives and the hospital industry: Are we expecting too much?","attachmentId":45255431,"attachmentType":"pdf","work_url":"https://www.academia.edu/24926381/Profit_incentives_and_the_hospital_industry_Are_we_expecting_too_much","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/24926381/Profit_incentives_and_the_hospital_industry_Are_we_expecting_too_much"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="7" data-entity-id="51791889" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/51791889/How_Does_Payer_Mix_and_Technical_Inefficiency_Affect_Hospital_Net_Revenue">How Does Payer Mix and Technical Inefficiency Affect Hospital Net Revenue?</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="120057370" href="https://independent.academia.edu/VivianValdmanis">Vivian Valdmanis</a></div><p class="ds-related-work--metadata ds2-5-body-xs">2012</p><p class="ds-related-work--abstract ds2-5-body-sm">As changes in the US health care system continue to evolve and change, maintaining the financial viability of hospitals is crucial to the system’s operation. Two lines of inquiry have been pursued in describing factors affecting financial viability. The first line of inquiry relates to the external payer mix of patients focusing on patients who are unable to compensate hospitals</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"How Does Payer Mix and Technical Inefficiency Affect Hospital Net Revenue?","attachmentId":69357950,"attachmentType":"pdf","work_url":"https://www.academia.edu/51791889/How_Does_Payer_Mix_and_Technical_Inefficiency_Affect_Hospital_Net_Revenue","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/51791889/How_Does_Payer_Mix_and_Technical_Inefficiency_Affect_Hospital_Net_Revenue"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="8" data-entity-id="91744734" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/91744734/Effects_of_Competition_Under_Prospective_Payment_on_Hospital_Costs_Among_High_and_Low_Cost_Admissions_Evidence_from_California_1983_and_1993">Effects of Competition Under Prospective Payment on Hospital Costs Among High- and Low-Cost Admissions: Evidence from California, 1983 and 1993</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="371700" href="https://chicago.academia.edu/DavidOMeltzer">David Meltzer</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Forum for Health Economics & Policy, 2002</p><p class="ds-related-work--abstract ds2-5-body-sm">Competition and prospective payment systems have been widely used to attempt to control health care costs. Although much of the increase in medical costs over the past half-century has been concentrated among a few high-cost users of health care, prospective payment systems may provide incentives to reduce expenditures selectively on high-cost users relative to low-cost users, and this pressure may be increased by competition. We use data on hospital charges and cost-to-charge ratios from California in 1983 and 1993 to examine the effects of competition on costs for high- and low-cost admissions before and after the establishment of the Medicare Prospective Payment System (PPS). Comparing persons above and below age 65 before and after the establishment of PPS, we find that competition is associated with increased costs before PPS in both age groups, but decreased costs afterwards, especially among those above age 65 with the highest costs. We conclude that the combination of compet...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Effects of Competition Under Prospective Payment on Hospital Costs Among High- and Low-Cost Admissions: Evidence from California, 1983 and 1993","attachmentId":94944258,"attachmentType":"pdf","work_url":"https://www.academia.edu/91744734/Effects_of_Competition_Under_Prospective_Payment_on_Hospital_Costs_Among_High_and_Low_Cost_Admissions_Evidence_from_California_1983_and_1993","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/91744734/Effects_of_Competition_Under_Prospective_Payment_on_Hospital_Costs_Among_High_and_Low_Cost_Admissions_Evidence_from_California_1983_and_1993"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="9" data-entity-id="72538291" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/72538291/The_Effects_of_Global_Budget_Payments_on_Hospital_Utilization_and_Quality_in_Rural_Maryland">The Effects of Global Budget Payments on Hospital Utilization and Quality in Rural Maryland</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="4912160" href="https://jhsph.academia.edu/NicolaeDone">Nicolae Done</a></div><p class="ds-related-work--metadata ds2-5-body-xs">2017</p><p class="ds-related-work--abstract ds2-5-body-sm">Provider payment reform has become a prominent strategy for health policy makers seeking to reduce spending and achieve higher health care value over the past several decades. Global budgets are promising as a payment method that caps health care expenditures, although countries like Germany, France, Canada, and Taiwan have implemented very different models. 1 In the United States, global budgets have been implemented for Maryland hospitals as one of several initiatives and demonstration programs that seek to shift provider incentives from focusing on service volume to rewarding higher quality and reductions in wasteful care. These alternative payment models include the formation of risk-taking Accountable Care Organizations (ACOs), bundled payments, primary care transformation initiatives, and pay-for-performance (P4P) programs. 2 As the shift to value-based payment is set to accelerate both within Medicare 3 and among commercial payers and Medicaid programs, 4-6 it is critical to</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"The Effects of Global Budget Payments on Hospital Utilization and Quality in Rural Maryland","attachmentId":81427635,"attachmentType":"pdf","work_url":"https://www.academia.edu/72538291/The_Effects_of_Global_Budget_Payments_on_Hospital_Utilization_and_Quality_in_Rural_Maryland","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/72538291/The_Effects_of_Global_Budget_Payments_on_Hospital_Utilization_and_Quality_in_Rural_Maryland"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div></div></div><div class="ds-sticky-ctas--wrapper js-loswp-sticky-ctas hidden"><div class="ds-sticky-ctas--grid-container"><div class="ds-sticky-ctas--container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--sticky-ctas","attachmentId":47123729,"attachmentType":"pdf","workUrl":null}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--sticky-ctas","attachmentId":47123729,"attachmentType":"pdf","workUrl":null}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div></div></div><div class="ds-below-fold--grid-container"><div class="ds-work--container js-loswp-embedded-document"><div class="attachment_preview" data-attachment="Attachment_47123729" style="display: none"><div class="js-scribd-document-container"><div class="scribd--document-loading js-scribd-document-loader" style="display: block;"><img alt="Loading..." src="//a.academia-assets.com/images/loaders/paper-load.gif" /><p>Loading Preview</p></div></div><div style="text-align: center;"><div class="scribd--no-preview-alert js-preview-unavailable"><p>Sorry, preview is currently unavailable. 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A study of Health Service Organizations in Ontario</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="209769846" href="https://independent.academia.edu/JonathanLomas2">Jonathan Lomas</a></div><p class="ds-related-work--metadata ds2-5-body-xs">PubMed, 1996</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Do physician-payment mechanisms affect hospital utilization? 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Ellis</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of Health Economics, 1996</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Hospital response to prospective payment: Moral hazard, selection, and practice-style effects","attachmentId":68319761,"attachmentType":"pdf","work_url":"https://www.academia.edu/50271454/Hospital_response_to_prospective_payment_Moral_hazard_selection_and_practice_style_effects","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/50271454/Hospital_response_to_prospective_payment_Moral_hazard_selection_and_practice_style_effects"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="9" data-entity-id="52556312" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/52556312/The_Changing_Hospital_Industry_Comparing_For_Profit_and_Not_for_Profit_Institutions">The Changing Hospital Industry: Comparing For-Profit and Not-for-Profit Institutions</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="371700" href="https://chicago.academia.edu/DavidOMeltzer">David Meltzer</a></div><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"The Changing Hospital Industry: Comparing For-Profit and Not-for-Profit Institutions","attachmentId":69767002,"attachmentType":"pdf","work_url":"https://www.academia.edu/52556312/The_Changing_Hospital_Industry_Comparing_For_Profit_and_Not_for_Profit_Institutions","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/52556312/The_Changing_Hospital_Industry_Comparing_For_Profit_and_Not_for_Profit_Institutions"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="10" data-entity-id="75669771" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/75669771/A_Review_of_A_Comparison_of_Alternative_Medicare_Reimbursement_Policies_under_Optimal_Hospital_Pricing_">A Review of “A Comparison of Alternative Medicare Reimbursement Policies under Optimal Hospital Pricing”</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="37376314" href="https://independent.academia.edu/SilversJ">J. 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