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This reports presents findings from a study of design options and payment methods for a capitation payment plan for the Medicare End Stage Renal Disease (ESRD) Program. The study contributes to payment policy development by evaluating capitation as an alternative payment method to control Medicare costs while maintaining access and quality of care for ESRD patients. A capitation payment method has been developed that combines monthly capitation payments for dialysis and functioning graft patients with one-time payments for kidney transplant and graft failure events.

Chronic renal failure --- Hemodialysis --- Capitation fees (Medical care) --- Patients --- Services for --- Finance. --- Finance. --- United States.

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Chronic renal failure --- Physicians --- Medicare. --- Medical fees --- Government policy

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The authors of this study compared DRG weights calculated using the Hospital Specific Relative Value (HSRV) method with those calculated using the standard method for each year from 1985 through 1989, and analyzed differences between the two methods for 1989. They provide evidence suggesting that classification error and subsidies of higher weighted cases by lower weighted cases caused compression in the weights used for payment as late as the fifth year of Medicare's prospective payment system. However, later weights calculated by the standard method are not compressed because a statistical correlation between high markups and high case mix indices offsets the cross-subsidization. HSRV weights from the same files are compressed because this methodology is more sensitive to cross-subsidies. However, both sets of weights produce equally good estimates of hospital level costs net of those expenses that are paid by outlier payments. The greater compression of the HSRV weights is counterbalanced by the fact that more high-weight cases qualify as outliers.

Hospitals --- Diagnosis related groups. --- Economics, Hospital --- Medicare. --- Prospective payment --- Mathematical models.

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This study finds racial and financial characteristics influence the quality of care received by acutely ill, insured patients after hospital admission. The study uses a clinically detailed data set to examine a comprehensive range of services provided to patients with one of five serious, common diseases in different types of hospitals. The report examines quality of care provided to patients who are black, make use of Medicaid insurance in addition to Medicare, and live in poor neighborhoods, as compared with subsets of patients who are not black, do not have Medicaid insurance, and do not live in poor neighborhoods. It also compares quality of care for inner-city patients and rural patients with that for urban patients who are not poor.

Poor --- African Americans --- Rural hospitals --- Poor --- African Americans --- Medical care --- Evaluation. --- Medical care --- Evaluation. --- Evaluation. --- Hospital care --- Evaluation. --- Hospital care --- Evaluation.

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Health maintenance organizations. --- Hospitals --- Medical policy --- Health insurance --- Medicare. --- Prospective payment.