Berki S E
Med Care. 1983 Jan;21(1):1-13. doi: 10.1097/00005650-198301000-00001.
Reimbursing hospitals on the basis of treated cases, as in the New Jersey diagnosis-related groups (DRG) experiment, is equivalent to a centrally set pricing scheme, with all of its inherent difficulties. In addition to the problems of appropriate case definition, it is not obvious how hospitals should be classified to form reference groups for cost determination. Because empirically derived cost schedules are based on observed treatment patterns and resource use, they reflect variations in clinical appropriateness and quality and in resource use efficiency that characterize the system from which the data are drawn. If case-based schemes are to incorporate desirable performance incentives, they must be much better specified and take into account the complexity of hospital behavior. This article identifies the basic components of case-based systems of hospital reimbursement and discusses the analytic and empiric problems involved in their design.
像新泽西州诊断相关组（DRG）实验那样，根据治疗病例数对医院进行补偿，等同于一种中央设定的定价方案，存在其固有的所有困难。除了合适的病例定义问题外，如何对医院进行分类以形成用于成本确定的参照组并不明确。由于根据经验得出的成本计划基于观察到的治疗模式和资源使用情况，它们反映了临床合理性和质量以及资源使用效率方面的差异，这些差异是数据所源自的系统的特征。如果基于病例的方案要纳入理想的绩效激励措施，就必须进行更明确的规定，并考虑到医院行为的复杂性。本文确定了基于病例的医院补偿系统的基本组成部分，并讨论了其设计中涉及的分析和实证问题。
