Kominski G F, Rice T
School of Public Health, University of California Los Angeles, 90024, USA.
Health Care Financ Rev. 1994 Winter;16(2):175-89.
Medicare's use of diagnosis-related groups (DRGs) and the resource-based relative value scale (RBRVS) has led to interest in developing a national all-payer system in which insurers use the same payment methods and payment rates. Using data for 81 high-volume DRGs from 457 California hospitals, we conclude that a single set of rates for hospital care would not be appropriate. On average, Medicare patients were 11.7 percent more expensive than commercially insured patients, but less expensive in many DRGs. Further research is needed to determine if Medicare patients require more physician resources compared with non-Medicare patients, particularly for surgical procedures.
医疗保险对诊断相关分组（DRGs）和基于资源的相对价值尺度（RBRVS）的使用引发了人们对建立全国性全支付方系统的兴趣，在该系统中，保险公司采用相同的支付方式和支付费率。利用来自加利福尼亚州457家医院的81个高流量DRG的数据，我们得出结论，单一的一套医院护理费率并不合适。平均而言，医疗保险患者比商业保险患者的费用高出11.7%，但在许多DRG中费用较低。需要进一步研究以确定与非医疗保险患者相比，医疗保险患者是否需要更多的医生资源，特别是在外科手术方面。
