In: Economics
Hospitals are paid in various ways. When it comes to how Medicare has paid hospitals, there
have been both cost-plus and DRG methods of payment. Please explain these two payment
systems and discuss what the advantages and disadvantages of each are. Remember, this is an
economics class, so you should also think about incentives and efficiency. There has been talk of
moving toward episode based payment. What is episode based payment? How would it differ
from cost-plus and DRG payment (include incentives and efficiency here to)?
Cost plus system of payments : The retrospective reimbursement system is also called a cost-plus system under which reimbursement is paid to hospitals for an amount equal to their costs for treating the patient, plus a certain percentage above cost for profit and overhead.
Advantages : This system enable health care providers to provide more than enough services for the patients as they are not concerned with cutting costs. Extra services may include longer stays and medically unnecessary medical services.
Disadvantages : intricacy, volatility, and lack of incentives for providers to try and maximize efficiency and contain costs
DRG method of payment :
In this systems a patient is put in one of over 500 different
payment catergories based on thier original diagnosis, secondary
diagnoses, surgical procedures, other treatments, age, gender, and
if they were treated, transfered, or died. The managers of the
system assign a prospective payment for each group, which the
hospitals receive.
Advantages : Under this system, hospitals have to be be effiecent in diagnosing the patient at the very begininng and also must be able to manage their resources well
Disadvanatges : Some doctors have found ways around this system to perserve their profitability. This is accomplished by "upcoding" a patient upon their arrival to the hospital. Upcoding means diagnosing a paitient to a more extreme DRG group, in which they will recieve more money for that patient.