Differences in resource use and cost among facilities treating alcohol, drug abuse, and mental disorders: implications for design of a prospective payment system.
Specialized psychiatric facilities, including qualified distinct-part units in general hospitals, are exempt from Medicare's diagnosis-related group prospective payment system (PPS). One major reason for continuing the exemption is the redistribution of revenue that would probably occur if a single national price were established for care at the diverse facilities that treat patients with psychiatric and substance abuse disorders. This study investigated the extent of such potential redistribution in a private health insurance data base and found that a PPS would systematically underpay specialized facilities and systematically overpay general hospitals without specialized units. Alternatives for addressing this problem are discussed.
D000437:Alcoholism / Q000191:economics / Q000628:therapy; D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics; D006268:Health Facilities / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006769:Hospitals, General / Q000191:economics; D006778:Hospitals, Psychiatric / Q000191:economics*; D006779:Hospitals, Public / Q000191:economics; D006801:Humans; D007350:Insurance, Hospitalization / Q000191:economics; D007902:Length of Stay / Q000191:economics; D006278:Medicare / Q000191:economics*; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy; D011445:Prospective Payment System; D019966:Substance-Related Disorders / Q000191:economics* / Q000628:therapy; D014481:United States