Abstract
New Hampshire's new payment system for hospital psychiatric services is described. The system puts into practice arguments that incentives to reduce levels of care in a pure prospective payment system should be weakened and that “experience rating” should be used to ensure more fair payment to providers. This paper describes the system and summarizes the arguments.
Similar content being viewed by others
References
Camberg, L.G., & McGuire, T.G. (1989). Inpatient psychiatric units in nonteaching general hospitals: Response to public mental health policy or hospital economics?Medical Care, 27, 130–139.
Cromwell, J., Harrow, B., & McGuire, T.G. (1989, October).Towards a modified TEFRA payment system for exempt psychiatric units. Paper presented at the annual meeting of the American Public Health Association.
Ellis, R.P., & McGuire, T.G. (1986). Provider behavior under prospective reimbursement: Cost sharing and supply.Journal of Health Economics, Sept., 129–151.
Ellis, R.P., & McGuire, T.G. (1988) Insurance principles and design of prospective payment systems.Journal of Health Economics, 7, 215–237.
English, J.T., Sharfstein, S.S., Scherl, D.J., Astrachan, B., & Muzynski, I.L. (1986). Diagnosis-related groups and general hospital psychiatry: The APA study.The American Journal of Psychiatry, 142, 131–139.
Frank, R.G., Lave, J.R., Taube, C.A., Rupp, A., & Goldman, H.A. (1987). The impact of Medicare prospective payment system on psychiatric patients treated in scatterbeds. In T.G. McGuire & R. Scheffler (Eds.),Advances in health economics and health services research, Greenwich, CT: JAI Press.
Frank, R.G., & Lave, J.R. (in press). A comparison of hospital responses to reimbursement policies for Medicaid psychiatric patients.Rand Journal of Economics.
Frank, R.G., & Lave, J.R. (1985). The impact of Medicaid benefit design on length of hospital stay and patient transfers.Hospital and Community Psychiatry, 36, 749–754.
Frank, R.G., & Lave, J.R. (1986). The effect of benefit design on the length of stay of Medicaid psychiatric patients.The Journal of Human Resources, 21, 321–337.
Freiman, M., Ellis, R.P., & McGuire, T.G. (1989). Provider response to Medicare's PPS: Reductions in length of stay for psychiatric patients treated in scatter beds.Inquiry, 26, 192–201.
Freiman, M., Mitchell, J.B., & Rosenbach, M.L. (1987). An analysis of DRG-based reimbursement for psychiatric admissions to general hospitals.The American Journal of Psychiatry, 144, 603–609.
Jencks, S., Goldman, H., McGuire, T.G. (1985). Challenges in bringing exempt psychiatric services under a prospective payment system.Hospital and Community Psychiatry, 36, 764–769.
Jencks, S., Horgan, C., Goldman, H., & Taube, C.A. (1987). Bringing excluded psychiatric facilities under the Medicare prospective payment system: A review of research evidence and policy options.Medical Care,25, No. 9.
Lutterman, T., Glover, R., & Mazade, N. (1987).Funding sources and expenditures of state mental health agencies. Alexandria, VA: National Association of State Mental Health Program Directors.
Manderscheid, R.W., & Barrett, S.A. (1987).Mental health, United States, 1987 (DHHS Publication No. ADM 87-1518). Washington, DC: U.S. Government Printing Office.
McGuire, T.G., Dickey, B., Shively, G., & Strumwasser, I. (1987). DRGs and private health insurance: Implications for design of prospective payment systems.American Journal of Psychiatry, 144, 616–620.
McGuire, T.G. (1989). Financing and reimbursement for mental health services. In Taube & Mechanic (Eds.),The future of mental health services research (DHHS Publication No. ADM 89-1600). Washington, DC: U.S. Government Printing Office.
McGuire, T.G., & Scheffler, R. (Eds.). (1987).Research issues in economics and mental health. Greenwich, CT: JAI Press.
Mosakowski, W.S., & Magnusson, P.R. (1988). Design and development of a prospective payment system for inpatient psychiatric services. Report from Public Consulting Group, Inc., Boston, MA, to the Division of Mental Health and Developmental Services, State of New Hampshire.
Prospective Payment Assessment Commission. (1989).Medicare prospective payment and the American health care system: Report to the Congress.
Taube, C.A., et al. (1984). DRGs in psychiatry: An empirical evaluation.Medical Care, 22, 587–610.
Taube, C.A., Goldman. H.H., & Salkever, D. (1989). Medicaid coverage for mental illness: Balancing access and costs. (Unpublished manuscript).
Author information
Authors and Affiliations
Additional information
William S. Mosakowski is with the Public Consulting Group
Support for this research was provided by the New England Mental Health Commissioners' Association (NEMHCA), and grant number 1K05MH-00832-01 from the National Institute of Mental Health.
Rights and permissions
About this article
Cite this article
McGuire, T.G., Mosakowski, W.S. & Radigan, L.S. Designing a state-level prospective payment system for inpatient psychiatric services in medicaid. Adm Policy Ment Health 18, 43–54 (1990). https://doi.org/10.1007/BF00706491
Issue Date:
DOI: https://doi.org/10.1007/BF00706491