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The Prospective Payment System: A Civic Good, Not a Civil War

Fred Haruda, MD
JAMA. 1991;265(9):1112. doi:10.1001/jama.1991.03460090060028.
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To the Editor. —  The series of articles by the RAND Corporation authors1-8 is very provocative. However, I do not agree with conclusions reached by LoGerfo9 in his editorial. Wilensky10 stated that there were 11.7 million Medicare admissions in 1983 during the period that Keeler et al3 found that the 180-day mortality rate was 28.5%. Wilensky then stated that the Medicare admission rate was 10.4 million in the fiscal year of 1989, when Keeler's post— prospective payment death rate was 30.1%, a 1.6 percentage point increase.This translates into 166 400 more patient deaths per year for the same 10.4 million admissions after the institution of prospective payment, compared with deaths before the institution of this system. These numbers appear to show that the diagnosis related group (DRG)-based system has resulted in 166 400 deaths that would not have occurred had these same 10.4 million people


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