Weiner S L, Maxwell J H, Sapolsky H M, Dunn D L, Hsiao W C
Political Science Department, Massachusetts Institute of Technology, Cambridge 02139.
Milbank Q. 1987;65(4):463-87.
Diagnosis-related Groups (DRGs) offer hospitals financial incentives to improve efficiency. To be effective, DRGs require a realignment of management so that physicians' use of resources can be disciplined by administrators. The constituency for altering power relationships within hospitals, however, is, at best, a weak one: administrators see their primary task as the protection of physicians' clinical autonomy. Constraints imposed on hospitals by regulators can be accommodated by minor adjustments in behavior that ensure neither gains in efficiency nor changes in decision-making authority.
诊断相关分组（DRGs）为医院提高效率提供了经济激励。为了有效实施，DRGs需要重新调整管理方式，以便管理人员能够约束医生对资源的使用。然而，改变医院内部权力关系的支持者充其量是一个弱势群体：管理人员将他们的主要任务视为保护医生的临床自主权。监管机构对医院施加的限制可以通过行为上的微小调整来适应，这些调整既不能确保效率的提高，也不能改变决策权。
