《MEDICARE'S NEW HOSPITAL PAYMENT SYSTEM IS IT WORKING?》

CHAPTER ONE: Introduction1

Legislative History1

What Congress Expected from Prospective Payment3

What This Book Is About4

CHAPTER TWO: How Prospective Rates Work7

What's Covered, What's Not8

The Patient Classification System: Diagnosis-Related Groups9

How Rates Are Calculated11

The Rest of the System17

Issues19

CHAPTER THREE: Changes in the Pattern of Medical Services24

Inpatient Hospital Services25

Posthospital Care35

Physicians' Services and Outpatient Surgery43

CHAPTER FOUR: Effects on the Health of the Elderly47

Mortality of the Elderly under Prospective Payment48

Other Measures of Quality52

The Peer Review Organizations (PROs)60

Quality over the Longer Term66

CHAPTER FIVE: The Financial Impact of Prospective Payment69

The Hospital Insurance Trust Fund70

Enrollees' Out-of-Pocket Expenses75

Other Payers77

Hospitals78

CHAPTER SIX: Conclusions83

A Preliminary Assessment83

Toward Better Quality Care85

The Rate-Setting System88

How Much for Medical Care?90

Notes93

Index111