Adamow C L, Clipper A J
J Am Diet Assoc. 1985 Dec;85(12):1616-9.
Much concern has been generated about the impact of the diagnosis-related group (DRG) prospective payment system on a variety of medical treatments. In particular, high technology medical or surgical applications, such as enteral and parenteral nutrition support, are often perceived as cost-increasing rather than cost-reducing. The threat to the use of nutrition support services relates to the non-existence of an effective reimbursement scheme for recovery of labor costs for the services. High overhead and relatively expensive hard- and software may price nutrition services out of the health care system if an appropriate reimbursement plan is not developed. To address the obvious lack of provision for reimbursement of nutrition support services under the DRG system, several cost-benefit issues related to the provision of nutrition support must be addressed. Empirical data are necessary to determine the clinical significance of these procedures relative to severity and duration of illness and subsequent associated length-of-stay issues; and the cost-benefit justification of nutrition support for acute and chronically ill patients. The purpose of this discussion is not to propose such a system of reimbursement but rather to present a framework for the development and justification of a revised DRG reimbursement plan to cover adequately the cost of providing enteral and parenteral nutrition support services.
诊断相关分组（DRG）预付费系统对各种医疗治疗的影响引发了诸多关注。特别是，高科技医疗或外科应用，如肠内和肠外营养支持，通常被认为会增加成本而非降低成本。营养支持服务使用面临的威胁在于不存在有效的报销方案来补偿这些服务的劳动力成本。如果不制定适当的报销计划，高昂的间接费用以及相对昂贵的硬件和软件可能会使营养服务在医疗保健系统中价格过高而无法使用。为解决DRG系统下营养支持服务报销明显不足的问题，必须解决与提供营养支持相关的几个成本效益问题。需要实证数据来确定这些程序相对于疾病严重程度和持续时间以及随后相关住院时间问题的临床意义；以及为急性和慢性病患者提供营养支持的成本效益合理性。本次讨论的目的不是提出这样一种报销系统，而是提出一个框架，用于制定和论证修订后的DRG报销计划，以充分涵盖提供肠内和肠外营养支持服务的成本。
