Should insurers pay the same fees under an all-payer system?
Medicare's use of diagnosis-related groups (DRGs) and the resource-based relative value scale (RBRVS) has led to interest in developing a national all-payer system in which insurers use the same payment methods and payment rates. Using data for 81 high-volume DRGs from 457 California hospitals, we conclude that a single set of rates for hospital care would not be appropriate. On average, Medicare patients were 11.7 percent more expensive than commercially insured patients, but less expensive in many DRGs. Further research is needed to determine if Medicare patients require more physician resources compared with non-Medicare patients, particularly for surgical procedures.
School of Public Health, University of California Los Angeles, 90024, USA.
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D002140:California; D006297:Health Services Accessibility; D006302:Health Services Research / Q000379:methods; D007350:Insurance, Hospitalization / Q000592:standards* / Q000706:statistics & numerical data; D007357:Insurance, Physician Services / Q000592:standards* / Q000706:statistics & numerical data; D009937:Organizational Objectives; D017149:Private Sector; D011445:Prospective Payment System; D017150:Public Sector; D011907:Rate Setting and Review / Q000592:standards*; D012044:Regression Analysis; D015895:Relative Value Scales