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Under the prospective payment system (PPS) introduced in 1983, hospitals are to be paid for each Medicare admission on the basis of a price per case set in advance, thus giving hospitals and other providers incentives for delivering care that are radically different from those of cost-reimbursement financing. This report identifies major issues relating to quality of care, sketches conceptual and practical aspects of carrying out appropriate studies of these issues, and outlines a quality-of-care research agenda. It emphasizes changes in hospital care that are most likely to occur secondary to PPS, those likely to have the most direct impact on patients' outcomes, and changes that can be defined, detected, and measured with relative ease. Certain themes for future research efforts are stressed: (1) the overall research agenda must be strong enough to detect clinically meaningful impacts on patient outcomes and to be able to assign those impacts to PPS; (2) outcomes other than death must be examined; (3) interpreting the impacts of PPS requires understanding the clinical circumstances of Medicare patients; (4) developing better outcome measures is essential; (5) targeting impact studies on high-priority topics will be unavoidable; and (6) a full picture of the effects of PPS requires a long-term perspective, extending beyond FY 1987.

Hospitals --- Older people --- Medical care --- Medicare. --- Health Services Research. --- Quality of Health Care --- Reimbursement, Prospective. --- Prospective payment --- Hospital care --- Quality control. --- economics. --- Health Insurance for Aged and Disabled, Title 18. --- United States.

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This report details the analyses that RAND performed to support the Health Care Financing Administration's efforts to design, develop and implement the Prospective Payment System for inpatient rehabilitation.

Hospitals. --- Hospitals - Rehabilitation services - Prospective payment - United States. --- Hospitals --- Inpatients --- Prospective Payment System --- Rehabilitation Centers --- Reimbursement Mechanisms --- Health Facilities --- Patients --- Persons --- Health Care Facilities, Manpower, and Services --- Insurance, Health, Reimbursement --- Health Care --- Financing, Organized --- Named Groups --- Economics --- Health Care Economics and Organizations --- Hospitals & Medical Centers --- Public Health --- Health & Biological Sciences --- Rehabilitation services --- Prospective payment --- Healthcare Economics and Organizations --- Capital --- Conditions, Economic --- Consumption --- Cost of Living --- Easterlin Hypothesis --- Economic Conditions --- Economic Factors --- Economic Policies --- Economic Policy --- Economics, Home --- Factors, Economic --- Home Economics --- Household Consumption --- Macroeconomic Factors --- Microeconomic Factors --- Policies, Economic --- Policy, Economic --- Production --- Remittances --- Utility Theory --- Consumer Price Index --- Condition, Economic --- Consumer Price Indices --- Consumption, Household --- Economic Condition --- Economic Factor --- Factor, Economic --- Factor, Macroeconomic --- Factor, Microeconomic --- Factors, Macroeconomic --- Factors, Microeconomic --- Household Consumptions --- Hypothesis, Easterlin --- Index, Consumer Price --- Indices, Consumer Price --- Living Cost --- Living Costs --- Remittance --- Theories, Utility --- Theory, Utility --- Utility Theories --- Community Financing --- Grants --- Organized Financing --- Financing, Community --- Grant --- Community-Based Distribution --- Contraceptive Distribution --- Delivery of Healthcare --- Dental Care Delivery --- Distribution, Non-Clinical --- Distribution, Nonclinical --- Distributional Activities --- Healthcare --- Healthcare Delivery --- Healthcare Systems --- Non-Clinical Distribution --- Nonclinical Distribution --- Delivery of Dental Care --- Health Care Delivery --- Health Care Systems --- Activities, Distributional --- Activity, Distributional --- Care, Health --- Community Based Distribution --- Community-Based Distributions --- Contraceptive Distributions --- Deliveries, Healthcare --- Delivery, Dental Care --- Delivery, Health Care --- Delivery, Healthcare --- Distribution, Community-Based --- Distribution, Contraceptive --- Distribution, Non Clinical --- Distributional Activity --- Distributions, Community-Based --- Distributions, Contraceptive --- Distributions, Non-Clinical --- Distributions, Nonclinical --- Health Care System --- Healthcare Deliveries --- Healthcare System --- Non Clinical Distribution --- Non-Clinical Distributions --- Nonclinical Distributions --- System, Health Care --- System, Healthcare --- Systems, Health Care --- Systems, Healthcare --- Third-Party Payers --- Health Insurance Reimbursement --- Reimbursement, Health Insurance --- Third-Party Payments --- Health Insurance Reimbursements --- Insurance Reimbursement, Health --- Insurance Reimbursements, Health --- Payer, Third-Party --- Payers, Third-Party --- Payment, Third-Party --- Payments, Third-Party --- Reimbursements, Health Insurance --- Third Party Payers --- Third Party Payments --- Third-Party Payer --- Third-Party Payment --- Healthcare Facilities, Manpower, and Services --- Person --- Clients --- Client --- Patient --- Facilities, Health --- Facility, Health --- Health Facility --- Mechanism, Reimbursement --- Mechanisms, Reimbursement --- Reimbursement Mechanism --- Centers, Rehabilitation --- Center, Rehabilitation --- Rehabilitation Center --- Adjustment, Discretionary --- Discretionary Adjustment Factor --- Prospective Pricing --- Prospective Reimbursement --- Reimbursement, Prospective --- Adjustment Factor, Discretionary --- Adjustment Factors, Discretionary --- Adjustments, Discretionary --- Discretionary Adjustment --- Discretionary Adjustment Factors --- Discretionary Adjustments --- Factor, Discretionary Adjustment --- Factors, Discretionary Adjustment --- Payment System, Prospective --- Payment Systems, Prospective --- Pricing, Prospective --- Prospective Payment Systems --- Prospective Reimbursements --- Reimbursements, Prospective --- System, Prospective Payment --- Systems, Prospective Payment --- Inpatient --- Benevolent institutions --- Infirmaries --- Health facilities --- Prospective Payment System. --- Inpatients. --- economics. --- United States.