ASSESSING MEDICARE'S PROSPECTIVE PAYMENT SYSTEM IN THE CONTEXT OF RURAL HEALTHCARE DELIVERY AN APPALACHIAN CASE STUDY

Medicare's prospective payment system often provides inadequate reimbursement for rural hospitals, especially for those patients called "outliers" whose inpatient care needs greatly exceed nationally established averages. This paper domirents spatial and medical characteristics of outliers and their communities in a 1986 case study of outliers from West Virginia University Hospital. Distances from their homes to the hospital and the lower levels
of healthcare characteristic of rural comrmnities (both primary care and long-term care) contribute to outliers' longer lengths of stay in the hospital. Community-based healthcare now shoulders an even greater burden of care for the rural elderly.