Will payment based on diagnosis-related groups control hospital costs?
Will payment based on diagnosis-related groups control hospital costs?
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按诊断相关群体付费能否控制医院费用？
DOI：
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发表时间：
1984
影响因子：
158.5
通讯作者：
P. Caper
中科院分区：
文献类型：
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作者：
John E. Wennbero;K. McPherson;P. Caper
以前的研究表明，一些外科手术的入院率，如子宫切除术，在医院市场区域之间差异很大，显然是因为医生的执业风格不同。为了了解大多数入院原因是否存在这种差异，我们将1980年至1982年缅因州所有非产科内科和外科住院患者分为诊断相关组（DRG），并测量了30个医院市场区域的入院率差异。子宫切除率相差3.5倍，但90%的内科和外科住院病例属于DRGs，其住院率甚至更不稳定，这表明专业判断在决定大多数DRGs的住院治疗方面起着重要作用。如果医生在当前医疗适当性的限度内修改其入院政策以产生更多利润，则DRG支付系统导致的医院收入损失可以被抵消。如果发生这种情况，DRG计划的净效应将是加剧医院成本膨胀。我们的结论是，要取得成功，成本控制计划的基础上固定，每次入院的医院价格将需要确保有效控制住院率。
Previous studies have shown that the admission rates for a few surgical procedures, such as hysterectomy, vary extensively among hospital market areas, apparently because of differences in physicians' practice styles. To see whether such variations occur for most causes of admission, we classified all nonobstetrical medical and surgical hospitalizations in Maine for the years 1980 through 1982 into diagnosis-related groups (DRGs) and measured the variations in admission rates among 30 hospital market areas. Hysterectomy rates varied 3.5-fold, but 90 per cent of medical and surgical admissions fell into DRGs for which admission rates were even more variable, suggesting that professional discretion plays an important part in determining hospitalization for most DRGs. Losses in hospital revenues resulting from the DRG payment system could be offset if physicians modified their admission policies to produce more profit, well within the current limits of medical appropriateness. If this occurred, the net effect of a DRG program would be to exacerbate hospital cost inflation. We conclude that, to be successful, cost-containment programs based on fixed, per-admission hospital prices will need to ensure effective control of hospitalization rates.