Posting date: August 9, 2005

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Health Affairs, 10.1377/hlthaff.w5.376
Copyright © 2005 by Project HOPE

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When The Price Isn't Right: How Inadvertent Payment Incentives Drive Medical Care

¹ Paul Ginsburg is president of the Center for Studying Health System Change in Washington, D.C.
² Joy Grossman is a senior researcher at the Center for Studying Health System Change.

^*Corresponding author.

Abstract

Unintended overpayment of some services, in combination with other market factors, is driving increased use of expensive care, which in turn could be an important driver of health care cost trends. Reimbursement systems are highly dependent on provider charge data that rarely provide accurate and up-to-date indicators of relative costs. As a result, newer services, in which productivity is increasing over time, tend to be more lucrative. As the largest payer, and one whose reimbursement policies are followed by private insurers and Medicaid programs, Medicare can address this issue by taking steps to make its prospective payment rates reflect relative costs more accurately.

Key Words: Business Of Health, Legal/Regulatory Issues, Medicaid, Medicare, Health Spending, Insurance Market

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