诊断相关分组（DRGs）与医疗保险的前瞻性支付

DRGs and prospective payment under Medicare.

作者信息

Young D A

出版信息

Med Decis Making. 1985;5(1):7-13. doi: 10.1177/0272989X8500500102.

Abstract

In moving from cost-based reimbursement to a DRG-based prospective system, the Medicare Prospective Payment System (PPS) has radically restructured the financial incentives for the care of patients. The incentives potentially may lead to increased hospital admissions, decreased lengths of stay, decreased volume of services to some individuals, service shifts outside the hospital, and increased selectivity/specialization by hospitals in limited DRGs. The Prospective Payment Assessment Commission (ProPAC) is charged with evaluating important issues and factors affecting the implementation of the PPS and with making recommendations for improving system performance.

摘要

从基于成本的报销转向基于诊断相关分组（DRG）的前瞻性系统，医疗保险前瞻性支付系统（PPS）已从根本上重塑了患者护理的财务激励机制。这些激励措施可能会导致住院人数增加、住院时间缩短、某些个体的服务量减少、医院外的服务转移，以及医院在有限的DRG中提高选择性/专业化程度。前瞻性支付评估委员会（ProPAC）负责评估影响PPS实施的重要问题和因素，并就改善系统性能提出建议。