a wordCase rate

One flat amount for one case, agreed in advance. A trade description puts it at its bluntest: under a case rate "providers receive a flat reimbursement rate for every patient visit, no matter what service they provide". Acuity has no bearing on the payment, which is the point and also the problem.

The form sits between two better-documented ones. A DRG is a case rate that has been sorted into hundreds of clinically defined groups with weights drawn from average costs, so a complicated case is paid more than a simple one. A bundled payment is a case rate stretched across several providers and a stated number of days. A plain contracted case rate has neither: one price, one procedure, one provider.

Inference — that is why the case rate is the form a foreign hospital's price page most resembles. A published package for a named operation, with no severity adjustment and no episode window, is a case rate offered to the public instead of negotiated with a payer — and the risk it carries is the same risk, moved onto whoever accepted the price.

Two questions decide whether a case rate holds: what happens to a case that turns out to be more complicated than the rate assumed, and who decided it was more complicated. On a payer contract the answer is in a severity or outlier clause. On a hospital's package page abroad the answer is usually the eligibility list — the conditions under which the published price stops applying.

As of 17 September 2026 this site records prices in the form the seller published them. Where a figure is a payer's negotiated rate rather than a price a patient can pay, it is recorded as a tariff and named as one.