One of the key terms in contracts between hospitals and insurers is how the parties apportion the financial risk of treating unexpectedly costly patients. “Prospective” payment contracts give hospitals a lump-sum amount, depending on the medical condition of the patient, with limited adjustment for the level of services provided. We use data from the Medicare Prospective Payment System and commercial insurance plans covering the nonelderly through the Health Care Cost Institute to measure the extent of prospective payment in 303 metropolitan statistical areas during 2008–12. We find that the extent of prospective payment in commercial insurance is lower and more variable across hospitals and geographic areas than in Medicare. In addition, we find that the differences in prospective payment across hospitals is positively associated with hospital market competitiveness, the share of admissions paid by commercial managed care plans, and the share paid by the Medicare Prospective Payment System.

中文翻译：

---

商业健康计划为何不使用预期付款？

医院与保险公司之间的合同中的关键术语之一是当事方如何分摊治疗意料之外的昂贵患者的财务风险。“预见性”付款合同根据患者的医疗状况为医院提供一笔总付额，但对所提供服务水平的调整有限。我们使用来自Medicare预期付款系统的数据以及通过医疗保健成本研究所涵盖非老年人的商业保险计划来测量2008-12年度303个大都市统计区域中的预期付款范围。我们发现，与Medicare相比，各医院和地理区域中商业保险中预期付款的程度更低且变化更大。此外，