Agnes Rupp

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Institutional Affiliation: National Institutes of Health

NBER Working Papers and Publications

September 1986The Impact of Medicare's Prospective Payment System on Psychiatric Patients Treated in Scatterbeds
with Richard G. Frank, Judith R. Lave, Carl A. Taube, Howard H. Goldman: w2030
Medicare's Prospective Payment System (PPS) for hospitals was phased-in during the 1884 Federal Fiscal Year. While many providers of psychiatric inpatient care were exempted from PPS patients treated in general hospital beds outside of psychiatric units (scatterbeds) were not. This allows for an initial assessment of the impact of PPS on psychiatric patients. We use a single equation model of hospital length of stay to estimate the impact of PPS. We allow for the possibility of both anticipating behavior and slow adjustment to the new payment scheme. The results indicate a substantial response to PPS over the first year of implementation. The estimated response includes sizable anticipatory and slow adjustment components. The findings suggest that policy discussions may be weighted too hea...

Published: in T. G. McGuire and R.M. Scheffler, editors, The Economics of Mental Health Services. Advances in Health Economics and Health Services Research, Volume 8, JAI Press, 1987.

June 1985Hospital Cost and Efficiency Under Per Service and Per Case Payment in Maryland: A Tale of the Carrot and the Stick
with David S. Salkever, Donald M. Steinwachs: w1633
The simultaneous operation of per case and per servicepayment systems in Maryland, and the varying levels of stringency used in setting per case rates allows comparison of effects of differing incentive structures on hospital costs. This paper presents such a comparison with 1977-1981 data. Cost per case and total cost regressions show evidence of lower costs only when per case payment limits are very stringent. Positive net revenue incentives appear insufficient to induce reductions in length of stay and in ancillary services use. Our results suggest these changes in medical practice patterns are more likely under the threat of financial losses.

Published: Salkever, David S., Donald M. Steinwachs, and Agnes Rupp."Hospital Cost and Efficiency Under Per Service and Per Case Payment in Maryland: A Tale ofthe Carrot and the Stick." Inquiry, Vol. 23, (Spring 1986), pp. 56-66.

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