The Impact of the Inpatient Prospective Payment System and Diagnosis-Related Groups

Abstract

The outpatient prospective payment system for the Medicare program became effective Aug. 1, 2000, as mandated by the Balanced Budget Act of 1997. This outpatient program complements Medicare’s inpatient prospective payment system, which was introduced in 1983. A survey of the literature over the past 20 years is undertaken to review the effects of the inpatient prospective payment system and diagnosis-related groups (DRGs) on inpatient hospital utilization, expenditures, and outcomes. The level of the DRG payment has been questioned, as well as the process of adjusting the payment levels from one year to the next. In addition, past research has speculated that the DRG classification may not be sensitive to severity and is subject to coding ambiguities. These conclusions can be used as input to future research on the new outpatient program, as well as updating research on the inpatient program.     

Reviews

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BEYOND THE INNER CITY.

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REGIONAL DEVELOPMENT.

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Two estimators for the apt model when factors are measured

Non-linear SUR and ITSUR techniques are proposed for the estimation of the APT and the CAPM when the factors are observed. These techniques estimate all of the parameters of the model simultaneously and directly impose the model's non-linear parameter restrictions.     

A Note on Laurence Seidman’s Article

Mihail Manoilescu was among the foremost intellectual figures of the interwar period in Romania. He was known as a politician and central banker, as well as an economist. From the very beginning of his theoretical and practical career, or at least from the late 1920s onward, Manoilescu’s ideas and theories (especially his corporatist theory) were marked by clear continuity and consistency based on the theory of protectionism grounded on productivity differences. By developing his model — an alternative to the theory of comparative advantage — Manoilescu endeavored to show the need for protectionist measures to promote the development of peripheral countries. His defense of protectionism is usually presented as clumsy and founded on an incorrect method, even if he is often recognized as the forerunner of the theory of unequal exchange and the dependency theory. Few scholars note the similarity of Manoilescu’s theory with Karl Marx’s labor theory. This paper contributes to validating Manoilescu’s conclusions, the soundness of which we test here by reconstructing the theory from a Marxian perspective. A reconstruction of this type offers new possibilities of evaluating his theory and a better understanding of its contributions and limitations.     

Taking a positive approach to organizational downsizing

We drew from the literature on positive organizational behaviour (Luthans & Youssef, 2007) to test a process model relating generalized optimism (Carver & Scheier, 1999) to the cognitions, affect, and behaviour of 237 Canadian federal government managers during and following a major organizational downsizing. Our data supported a model in which generalized optimism measured 18 months prior to the downsizing (T1) associated positively with managers' cognitions, attitudes, job performance, and self‐reported coping effectiveness measured 12 months postdownsizing (T3). Analyses suggested that some of these associations were partially mediated by a positive thinking coping strategy and expectations for future career and job success reported during the downsizing (T2). We advocate for more research that draws from the positive organizational behaviour literature to study the effects of downsizing on survivors. Copyright © 2008 ASAC. Published by John Wiley & Sons, Ltd.     

Intraurban residential mobility: The role of transactions costs, market imperfections, and household disequilibrium

This paper presents a model of household residential search and mobility that focuses on microeconomic elements of household behavior and incorporates housing market features. The model is cast explicitly in terms of a rigorous model of housing demand, allowing the benefits from moving to be measured as the compensating income variation of the potential change in consumption. The empirical results indicate that large changes in economic variables, such as income and prices produce only small potential gains from moving and that a major factor in the moving decision is the magnitude of search and moving costs.     

Goodness of fit for seemingly unrelated regressions: Glahn's R2y.x and Hooper's r̄2

This paper presents a measure of goodness of fit for Zellner's seemingly unrelated regressions. The measure is a monotonic transform of the appropriate (asymptotic) F-statistic, is bounded on [0, 1] and is maximized by Zellner's estimation technique. Glahn's composite correlation coefficient is shown to be a special case of this measure. It is also compared to Hooper's squared trace correlation coefficient. All three measures as well as some additional asymptotic summary test statistics are calculated for the two-equation example of Zellner. The applicability of the latter test statistics seems not to be recognized in applied work.     

Myth in design

Conclusion Like our society, design is riddled with myths. Not all are harmful. Indeed, there is often a symbiotic relationship. Myths are also useful as a learning device in which the unintelligible —randomness, is reduced to the intelligible — a pattern. However, if we are striving, as designers, to gain understanding, to have gnosis, then an awareness of the role of myth in design is essential.Myth in design is important because, in casting ideas into tangible forms, it affects the way we think and behave; it not only reflects our past and present, it can also determine our future.