Do case-mix adjusted nursing home reimbursements actually reflect costs? Minnesota's experience

John A. Nyman, Robert A. Connor

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Some states have adopted Medicaid reimbursement systems that pay nursing homes according to patient type. These case-mix adjusted reimbursements are intended in part to eliminate the incentive in prospective systems to exclude less profitable patients. This study estimates the marginal costs of different patient types under Minnesota's case-mix system and compares them to their corresponding reimbursements. We find that estimated costs do not match reimbursement rates, again making some patient types less profitable than others. Further, in confirmation of our estimates, we find that the percentage change in patient days between 1986 and 1990 is explained by our profitability estimates.

Original languageEnglish (US)
Pages (from-to)145-162
Number of pages18
JournalJournal of Health Economics
Volume13
Issue number2
DOIs
StatePublished - Jul 1994

Keywords

  • Access
  • Case-mix reimbursement
  • Medicaid
  • Nursing homes
  • Profitability

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