Am J Psychiatry 1987; 144:616-620
Copyright © 1987 by American Psychiatric Association
Differences in resource use and cost among facilities treating alcohol, drug abuse, and mental disorders: implications for design of a prospective payment system
TG McGuire, B Dickey, GE Shively and I Strumwasser
Specialized psychiatric facilities, including qualified distinct-part units
in general hospitals, are exempt from Medicare's diagnosis- related group
prospective payment system (PPS). One major reason for continuing the
exemption is the redistribution of revenue that would probably occur if a
single national price were established for care at the diverse facilities
that treat patients with psychiatric and substance abuse disorders. This
study investigated the extent of such potential redistribution in a private
health insurance data base and found that a PPS would systematically
underpay specialized facilities and systematically overpay general
hospitals without specialized units. Alternatives for addressing this
problem are discussed.
