Hellinger F J
Inquiry. 1985 Spring;22(1):78-91.
Medicare's adoption of the Prospective Payment System (PPS) was the culmination of years of research and demonstrations to establish case-based systems for setting hospital rates. This paper examines the procedures and findings of the early programs in New Jersey and Maryland, as well as the Medicare case-based system that was established pursuant to the experience in these two states. This is followed by an examination of the recently established Medicaid case-based systems in Utah, Pennsylvania, Ohio, Michigan, and Washington and the case-based systems established by some Blue Cross and Blue Shield Plans. The strengths and weaknesses of these systems are discussed, and suggestions are made for improving the evaluations of these systems.
医疗保险采用预期支付系统（PPS）是多年研究和示范的成果，目的是建立基于病例的医院费率设定系统。本文考察了新泽西州和马里兰州早期项目的程序及结果，以及依据这两个州的经验建立的医疗保险基于病例的系统。接下来考察了犹他州、宾夕法尼亚州、俄亥俄州、密歇根州和华盛顿州最近建立的医疗补助基于病例的系统，以及一些蓝十字和蓝盾计划建立的基于病例的系统。讨论了这些系统的优缺点，并就改进这些系统的评估提出了建议。
