Quality of Care Before and After Implementation of the DRG-based Prospective Payment System

A Summary of Effects

Published in: JAMA, Journal of the American Medical Association, v. 264, no. 15, Oct. 17, 1990, p. 1989-1994

Posted on RAND.org on December 31, 1989

by William H. Rogers, David Draper, Katherine L. Kahn, Emmett B. Keeler, Lisa V. Rubenstein, Jacqueline Kosecoff, Robert H. Brook

Read More

Access further information on this document at jama.ama-assn.org

This article was published outside of RAND. The full text of the article can be found at the link above.

In this article the authors report on a mortality analysis, patient and hospital subgroup comparisons, and time series studies they have conducted in an attempt to determine whether changes in quality of care can be linked causally to the introduction of the prospective payment system. Based on these analyses the authors conclude that (1) mortality following hospitalization has been unaffected by the introduction of the prospective payment system, and improvements in in-hospital processes of care that began prior to the prospective payment system have continued after its introduction, but (2) the prospective payment system has increased the likelihood that a patient will be discharged home in an unstable condition. The authors recommend that efforts to correct this problem be intensified and that clinical monitoring of the impact of the prospective payment system continue as hospital cost-containment pressures intensify.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.