Abstract
South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced.
Original language | English (US) |
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Pages (from-to) | 63-70 |
Number of pages | 8 |
Journal | Health Care Financing Review |
Volume | 12 |
Issue number | 1 |
State | Published - Dec 1 1990 |
ASJC Scopus subject areas
- Health Policy