EARL STEINBERG, M.D., M.P.P.; GERARD F. ANDERSON, Ph.D.
Per-case hospital payment systems (systems in which a predetermined, fixed amount is paid per patient in a particular diagnostic category) are based on the concept of "averaging," the basic assumption being that, although a hospital may lose money on certain patients and earn a profit on others, an efficiently operated hospital will eventually "break even" or earn a small operating surplus in the course of treating many patients. This assumption remains valid as long as the classification system on which payments are based groups patients with similar costs into the same payment category and as long as patients with above-average
STEINBERG E, ANDERSON GF. Potential "Losers" Under Per-Case Payment. Ann Intern Med. ;106:904–906. doi: 10.7326/0003-4819-106-6-904
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Published: Ann Intern Med. 1987;106(6):904-906.
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