Maxwell J H, Sapolsky H M
Inquiry. 1987 Spring;24(1):57-67.
When Medicare implemented the diagnosis related group (DRG) method of reimbursement for hospitals in 1983, it already had a decade of experience using a prospective payment arrangement for its end stage renal disease (ESRD) program. We reviewed this experience to determine the lessons for Medicare's reimbursement of hospital services. The use of a fixed price for renal dialysis encouraged the introduction of cost-saving techniques. Failure to reduce the price for dialysis in keeping with the cost reductions, however, prevented the government from realizing the full benefits of prospective payment. In addition, there were important changes in medical practice that had independent effects on the program. Similar influences are likely to shape the impact of prospective payment on hospital behavior.
1983年医疗保险计划实施针对医院的诊断相关分组（DRG）报销方法时，它在其终末期肾病（ESRD）项目中采用前瞻性支付安排已有十年经验。我们回顾了这段经历，以确定医疗保险对医院服务报销的经验教训。对肾透析采用固定价格鼓励了成本节约技术的引入。然而，未能根据成本降低情况降低透析价格，阻碍了政府充分实现前瞻性支付的益处。此外，医疗实践中发生了一些重要变化，这些变化对该项目产生了独立影响。类似的影响可能会塑造前瞻性支付对医院行为的作用。
