James B. Couch, MD, JD; David B. Nash, MD, MBA
The prospective payment system for health services for Medicare beneficiaries has reversed the tide of "pay-as-you-go" reimbursement (1). In addition to the Medicare program, several state medical assistance programs and private health insurance plans have adopted this method of setting reimbursement in advance. Through prospective reimbursement, providers have gained the ability to analyze the costs of care more systematically, and usefully. But those who pay for the provision of health-care services—insurers, managed care organizations, corporations, labor unions, governmental agencies, consumers—also gained this ability. These purchasers are now beginning to demand accountability from providers for the quality and efficiency ("value") of
Couch JB, Nash DB. Severity of Illness Measures: Opportunities for Clinicians. Ann Intern Med. ;109:771–773. doi: 10.7326/0003-4819-109-10-771
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Published: Ann Intern Med. 1988;109(10):771-773.
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