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How does payment reform affect providers in competitive vs. non-competitive markets?

How does payment reform affect access to care?  And what does payment reform mean?

Payment reform can mean manythings but in this context we will mean substituting fee-for-service or cost-plus reimbursement schemes for fixed reimbursement for a fixed episodes of care or fixed bundles of services during a specific time frame.

One example of how payment reform worked, is Medicare’s Inpatient Prospective Payment System (IPPS).  One study using data from California in the early 1980s (Meltzer et al., 2002) found that costs fell more for providers in the most competitive markets after theIPPS was implemented.

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