Impact of State Hospital Prospective Reimbursement Programs on Medicare Hospital andd Non-Hospital Costs

摘要

Using Health Care Financing Administration Medicare 5% Medical History Sample File, hospital and non-hospital utilization and expenditures were analyzed on a county-year basis. The sample included 1,300 counties in 15 PR and all non-PR states for the 1974-78 period. Extensive descriptive and econometric analysis is performed using a quasi-experimental design. A literature review of hospital-nonhospital substitution is included, along with general modelling of Medicare reimbursement and cross-subsidization effects. Among the seven states with statistically significant results, six (including Connecticut and New York) showed reductions in total Medicare spending; only New Jersey was positive. No evidence was found of 'cost-shifting' to Medicare where it does not participate.