Should insurers pay the same fees under an all-payer system?
Kominski, Gerald F
Date of Pub
Medicare's use of diagnosis-related groups (DRGs) and the resource-based relative value scale (RBRVS) has led to interest
in developing a national all-payer system in which insurers use the same payment methods and payment rates. Using data for
81 high-volume DRGs from 457 California hospitals, we conclude that a single set of rates for hospital care would not be appropriate.
On average, Medicare patients were 11.7 percent more expensive than commercially insured patients, but less expensive in many
DRGs. Further research is needed to determine if Medicare patients require more physician resources compared with non-Medicare
patients, particularly for surgical procedures.
Prospective Payment System : Relative Value Scales : California : Health Services Accessibility : Health Services Research/methods
: Insurance, Hospitalization/statistics & numerical data/standards : Insurance, Physician Services/statistics & numerical
data/standards : Organizational Objectives : Private Sector : Public Sector : Rate Setting and Review/standards : Regression
Analysis : Support, U.S. Gov't, P.H.S.