Notman M, Howe K R, Rittenberg W, Bridgham R, Holmes M M, Rovner D R
Department of Anthropology, University of Colorado, Boulder.
Soc Sci Med. 1987;25(12):1259-67. doi: 10.1016/0277-9536(87)90124-9.
Prospective hospital reimbursement based on Diagnosis Related Groups (DRGs) began in 1983 for Medicare patients, and many states are adopting similar systems for Medicaid recipients in an attempt to curb rising health care costs. Because of their unprecedented intrusiveness compared to previous cost-containment measures and because they explicitly introduce financial incentives to reduce services, DRGs have great potential to affect health care delivery. To determine the effects of DRGs on hospitals and physicians, six months of ethnographic fieldwork was carried out on the medicine and pediatrics services of a university-affiliated hospital during the first year of DRG-based reimbursement. Observations and interviews were used to discern institutional responses to DRGs and physician knowledge of, experience with, and reactions to this cost-containment effort. Our findings indicate that the hospital instituted many changes to protect its interests. Data gathered from patients' abstracts suggest providers are successfully dealing with the new system; the average length of stay for Medicare patients was reduced by 38% in the first year of prospective reimbursement, compared with a 15% reduction for other patients (P less than 0.05). As a group, the physicians made no organized effort to educate themselves about the new cost-containment regulations. Their knowledge of DRGs was vague and included many misconceptions. Their response was not a coherent one taking broad social concerns into account. Cost-containment was viewed negatively, as a threat to the financial integrity of the hospital, patient care, and professional autonomy.(ABSTRACT TRUNCATED AT 250 WORDS)
基于诊断相关分组（DRGs）的前瞻性医院报销制度于1983年开始用于医疗保险患者，许多州也在为医疗补助接受者采用类似制度，试图遏制不断上涨的医疗费用。与以往的成本控制措施相比，DRGs具有前所未有的侵扰性，而且它们明确引入了减少服务的经济激励措施，因此对医疗服务的提供有很大影响。为了确定DRGs对医院和医生的影响，在基于DRG报销的第一年，对一家大学附属医院的内科和儿科服务进行了为期六个月的人种志实地研究。通过观察和访谈来了解机构对DRGs的反应以及医生对这种成本控制措施的了解、经验和反应。我们的研究结果表明，医院进行了许多变革以保护自身利益。从患者摘要中收集的数据表明，医疗服务提供者正在成功应对新系统；在前瞻性报销的第一年，医疗保险患者的平均住院时间减少了38%，而其他患者减少了15%（P小于0.05）。总体而言，医生们没有做出有组织的努力来了解新的成本控制规定。他们对DRGs的了解很模糊，还存在许多误解。他们的反应并非考虑到广泛社会关切的连贯反应。成本控制被视为负面因素，是对医院财务状况、患者护理和专业自主权的威胁。（摘要截选至250词）
