Which policy change associated with the Reagan administration significantly impacted hospital payment systems?

The implementation of the Medicare prospective payment system in hospitals during the Reagan administration was a significant change that fundamentally transformed how hospitals were reimbursed for services. This system shifted the way Medicare payments were determined from the previously used cost-based reimbursement to a fixed payment system based on diagnosis-related groups (DRGs). Under this prospective payment system, hospitals receive a predetermined amount of money for patient treatment based on the patient's diagnosis, regardless of the actual costs incurred during treatment.

This change incentivized hospitals to improve efficiency and manage costs because they would retain any savings if their treatment costs were below the fixed payment amount. Consequently, it altered hospital financial practices and led to greater scrutiny of length-of-stay and resource utilization. Ultimately, this policy aimed to control skyrocketing healthcare costs and ensure that Medicare could sustain its funding over the long term by providing a more predictable payment structure.

The other options, such as national health insurance, Medicaid program establishment, and the Affordable Care Act, either refer to different healthcare reforms or programs that emerged in other contexts and did not directly impact hospital payment structures in the same way as the prospective payment system did during the Reagan administration.