A comparison of alternative medicare reimbursement policies under optimal hospital pricing.
This paper applies and extends the use of a nonlinear hospital pricing model, recently posited in the literature by Dittman and Morey [1]. That model applied a hospital profit-maximizing behavior and studied the effects of optimal pricing of hospital ancillary services on the incidence of payment by private insurance companies and the Medicare trust fund. Here, we examine variations of the above model where both hospital profit-maximizing and profit-satisficing postures are of interest. We apply the model to three types of Medicare reimbursement policies currently in use or under legislative mandate to implement. The policies differ according to hospital size and whether cross-subsidies are allowed. We are interested in determining the effects of profit-maximizing and -satisficing behaviors of these three reimbursement policies on the levels of profits received, and on the respective implications for private payors and the Medicare trust fund.
D003361:Cost Allocation; D005376:Financial Management; D005377:Financial Management, Hospital; D006291:Health Policy; D007350:Insurance, Hospitalization; D006278:Medicare / Q000191:economics*; D008962:Models, Theoretical; D011907:Rate Setting and Review / Q000379:methods*; D012051:Reimbursement Mechanisms; D014481:United States