Journal
JOURNAL OF HEALTH ECONOMICS
Volume 23, Issue 2, Pages 369-389Publisher
ELSEVIER
DOI: 10.1016/j.jhealeco.2003.09.007
Keywords
for-profit; not-for-profit; hospital organization; Medicare; upcoding
Funding
- NIA NIH HHS [P01 AG019783-04, P01 AG19783, P01 AG019783] Funding Source: Medline
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Many hospitals in the 1990s many hospitals were accused of upcoding patient diagnostic related groups (DRGs) to increase Medicare reimbursements. We find that between 1989 and 1996, the percentage point share of the most generous DRG for pneumonia and respiratory infections rose by 10 points among not-for-profit hospitals, 23 points among for-profit hospitals, and 37 points in hospitals converting to for-profit status. Not-for-profit upcoding was also higher in markets with a larger for-profit hospital share. Upcoding appears to reflect both risk-taking by administrators and a closer alignment between the goals of the administration and the behavior of the clinical staff. (C) 2003 Elsevier B.V. All rights reserved.
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