Citation URL: http://www.urban.org/MarkEMiller

This report explores the feasibility and possible structure of alternative approaches to developing an all-payer prospective system for reimbursing hospitals for inpatient care. Included are a discussion of the derivation of case mix indexes, a discussion on constructing estimates of the average cost of an inpatient discharge, and a discussion on achieving Medicare savings. Also covered is a payment simulation model that covers average payments per discharge by hospital type, aggregate payments by hospital type, and distribution effects by hospital type.

Several health care reform proposals may result in Medicaid beneficiaries and the commercially insured being enrolled in a common purchasing pool. Little is known about the cost of Medicaid beneficiaries relative to the cost of the commercially insured within a given delivery system. This report analyzes the cost of Medicaid enrollees relative to the cost of commercial enrollees using data from nine health maintenance organizations. The cost data were derived from either claims data or encounter data.

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