Harrison D C
Am J Cardiol. 1985 Aug 23;56(5):10C-15C. doi: 10.1016/s0002-9149(85)80003-5.
In 1984, expenditures for health care in the United States were nearly $350 billion, more than 10% of the gross national product, and continued increases exceeding the general economic growth are projected. Cardiology and cardiovascular surgery represent a large part of this cost, reflecting the many new diagnostic and therapeutic procedures developed over the past 2 decades. Previous cost containment attempts failed because they provided no incentive to reduce spending for advanced technologies and procedures. A method of payment based on a case mix of 467 diagnosis related groups (DRGs), average duration of hospital stay and location of hospitals has been developed for Medicare. A 4-year trial using this method in New Jersey resulted in lower hospital costs per capita than in the rest of the country. In October 1983, a 3-year phase-in for all Medicare payments by the DRG method began. The 43 DRGs assigned to cardiology and cardiovascular surgery are among the highest-weighted for large reimbursement; thus, with the great number of aging patients with cardiac diagnoses, cardiology represents a very large share of the cost of medical care today. Because the quality of care can be determined and compared directly with costs, cardiology DRGs lend themselves to careful analysis. Three components will be examined. Coronary bypass surgery is the largest single reimbursement, thus the rationale for its use should be carefully studied. Coronary care units have markedly increased hospital costs for acute myocardial infarction, but have also improved care.(ABSTRACT TRUNCATED AT 250 WORDS)
1984年，美国的医疗保健支出接近3500亿美元，超过国民生产总值的10%，而且预计支出还会持续增长，增速超过总体经济增长。心脏病学和心血管外科手术占了这笔费用的很大一部分，这反映了过去20年中开发出的许多新诊断和治疗程序。以前控制成本的尝试都失败了，因为它们没有提供减少先进技术和程序支出的激励措施。一种基于467个诊断相关组（DRG）的病例组合、平均住院时间和医院位置的支付方法已为医疗保险制定出来。在新泽西州用这种方法进行的为期4年的试验使人均住院成本低于美国其他地区。1983年10月，开始了为期3年的向所有医疗保险支付采用DRG方法的逐步推行阶段。分配给心脏病学和心血管外科手术的43个DRG在大额报销中权重最高；因此，由于有大量患有心脏疾病的老年患者，心脏病学在当今医疗保健成本中占了很大份额。由于医疗质量可以直接与成本进行确定和比较，心脏病学DRG便于进行仔细分析。将研究三个组成部分。冠状动脉搭桥手术是最大的单项报销项目，因此应仔细研究其使用的基本原理。冠心病监护病房显著增加了急性心肌梗死的住院成本，但也改善了护理。（摘要截选至250词）
