National Hospital Rate-Setting Study. Volume IX. Case Study of Prospective Reimbursement in Western Pennsylvania

摘要

The prospective reimbursement program in western Pennsylvania has been administered by Blue Cross of Western Pennsylvania (BCWP) since the program started in 1971. The program is run with a staff of about fifteen. Analysts review budget proposals and negotiate specific items with hospitals. The voluntary nature of the program from 1974 to 1976 allowed hospitals to enter the program, receive a prospectively set operating budget, and then withdraw. After 1976, hospitals already in the program and those choosing to join were required to remain under prospective reimbursement through June of 1979. For fiscal year 1979, twenty-three of approximately ninety hospitals in the area served by BCWP participated in the program.