Davies R H, Westfall G
Health Serv Res. 1983 Summer;18(2 Pt 1):233-47.
This paper addresses the general concept of incorporating DRGs (Diagnosis Related Groups) into health care reimbursement systems and specifically addresses the problems and issues encountered in implementing a DRG-based hospital reimbursement system in the State of New Jersey during the period 1978-1982. We will frame the problem by briefly discussing the traditional problem with cost-based reimbursement systems, the objective and general methodology of patient classification, and the use of DRGs in hospital reimbursement. We then explore in some detail each phase of the process of constructing a workable prospective case-mix reimbursement system as it occurred in the State of New Jersey, discussing in particular the major reimbursement policy issues, their resolution, and impact on the system as a whole. Specific concerns addressed are patient data requirements, financial and statistical data requirements, the allocation of costs to patients, the development of prospective rates, the actual mechanics of payment, and current developments in New Jersey.
本文论述了将诊断相关分组（DRGs）纳入医疗保健报销系统的总体概念，并特别探讨了1978年至1982年期间在新泽西州实施基于DRG的医院报销系统时遇到的问题。我们将通过简要讨论基于成本的报销系统的传统问题、患者分类的目标和一般方法以及DRGs在医院报销中的应用来阐述这一问题。然后，我们将详细探讨在新泽西州构建可行的前瞻性病例组合报销系统过程的每个阶段，特别讨论主要的报销政策问题、其解决方案以及对整个系统的影响。所涉及的具体问题包括患者数据要求、财务和统计数据要求、成本分配给患者、前瞻性费率的制定、实际支付机制以及新泽西州的当前发展情况。
