Title

Prospective Payment: A Simulation Model Of Management Strategies.

Abstract

A simulation model developed to evaluate the financial effects of different management policies to face Medicare's Prospective Payment system is presented. This payment system, enacted by the US Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982, limits Medicare's reimbursement per patient to a fixed amount depending on the patient's particular type of disease. The reimbursement is based on a set of diagnosis related groups (DRGs), which categorizes patients into disease classifications. As a result, hospitals must make efficiency gains and managers must look for new ways to provide quality care while containing cost. SLAM was the simulation language chosen. The network and discrete-event portions are described in detail. The approach used to select specific DRGs for the analysis, as well as the statistical models used, preparation of input data, simulation routines and results of two runs are presented to illustrate how policies are simulated and results interpreted.

Publication Date

12-1-1985

Publication Title

Winter Simulation Conference Proceedings

Number of Pages

532-540

Document Type

Article; Proceedings Paper

Personal Identifier

scopus

Socpus ID

0022316697 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/0022316697

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