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Potential "Losers" Under Per-Case Payment
- EARL STEINBERG, M.D., M.P.P.; and
- GERARD F. ANDERSON, Ph.D.
Excerpt
Per-case hospital payment systems (systems in which a predetermined, fixed amount is paid per patient in a particular diagnostic category) are based on the concept of "averaging," the basic assumption being that, although a hospital may lose money on certain patients and earn a profit on others, an efficiently operated hospital will eventually "break even" or earn a small operating surplus in the course of treating many patients. This assumption remains valid as long as the classification system on which payments are based groups patients with similar costs into the same payment category and as long as patients with above-average
Acknowledgments
ACKNOWLEDGMENTS: Grant support: in part by grants from the Robert Wood Johnson Foundation, the John A. Hartford Foundation, and the American Society of Parenteral and Enteral Nutrition. (The views expressed in this editorial are those of the authors and do not necessarily reflect the opinions of the Robert Wood Johnson Foundation, the John A. Hartford Foundation, or the American Society of Parenteral and Enteral Nutrition.) Dr. Steinberg is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.
