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{
    "pk": 15055,
    "title": "Balancing Efficiency and Access: Discouraging Emergency Department Boarding in a Global Budget System",
    "subtitle": null,
    "abstract": "Reducing cost without sacrificing quality of patient care is an important yet challenging goal for healthcare professionals and policymakers alike. This challenge is at the forefront in the United States, where per capita healthcare costs are much higher than in similar countries around the world. The state of Maryland is unique in the hospital financing landscape due to its “capitation” payment system (also known as “global budget”), in which revenue for hospital-based services is set at the beginning of the year. Although Maryland’s system has yielded many benefits, including reduced Medicare spending, it also has had unintentional adverse consequences. These consequences, such as increased emergency department boarding and ambulance diversion, constrain Maryland hospitals’ ability to fulfill their role as emergency care providers and act as a safety net for vulnerable patient populations. In this article, we suggest policy remedies to mitigate the unintended consequences of Maryland’s model that should also prove instructive for a variety of emerging alternative payment mechanisms.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Health Care Cost, Health Policy, Capitation, Health Care Financing, Emergency Department, Ambulance Diversion, Access to Health Care"
        }
    ],
    "section": "Health Policy Perspectives",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/94z252kn",
    "frozenauthors": [
        {
            "first_name": "Benoit",
            "middle_name": "",
            "last_name": "Stryckman",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Diane",
            "middle_name": "",
            "last_name": "Kuhn",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Daniel",
            "middle_name": "B.",
            "last_name": "Gingold",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Kyle",
            "middle_name": "R.",
            "last_name": "Fischer",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "J. David",
            "middle_name": "",
            "last_name": "Gatz",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Stephen",
            "middle_name": "M.",
            "last_name": "Schenkel",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Brian",
            "middle_name": "J.",
            "last_name": "Brown",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        }
    ],
    "date_submitted": "2021-01-26T15:06:09Z",
    "date_accepted": "2021-01-26T15:06:09Z",
    "date_published": "2021-09-02T23:12:22Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/15055/galley/7688/download/"
        }
    ]
}