Comparison of Medicaid Payments Relative to Medicare Using Inpatient Acute Care Claims from the Medicaid Program: Fiscal Year 2010–Fiscal Year 2011
利用2010-2011年医疗补助和医疗保险索赔数据，比较医疗补助按服务收费的住院支付与医疗保险预期支付，发现医疗补助支付约为医疗保险的69%，且差距因州、住院时长和补充支付而异。
OBJECTIVE: To compare Medicaid fee-for-service (FFS) inpatient hospital payments to expected Medicare payments. DATA SOURCES: Medicaid and Medicare claims data, Medicare's MS-DRG grouper and inpatient prospective payment system pricer (IPPS pricer). STUDY DESIGN: Medicaid FFS inpatient hospital claims were run through Medicare's MS-DRG grouper and IPPS pricer to compare Medicaid's actual payment against what Medicare would have paid for the same claim. PRINCIPAL FINDINGS: Average inpatient hospital claim payments for Medicaid were 68.8 percent of what Medicare would have paid in fiscal year 2010, and 69.8 percent in fiscal year 2011. Including Medicaid disproportionate share hospital (DSH), graduate medical education (GME), and supplemental payments reduces a substantial proportion of the gap between Medicaid and Medicare payments. CONCLUSIONS: Medicaid payments relative to expected Medicare payments tend to be lower and vary by state Medicaid program, length of stay, and whether payments made outside of the Medicaid claims process are included.