按诊断相关分组定价与医院专业化

Rate-Setting by Diagnosis Related Groups and Hospital Specialization

RAND Journal of Economics · 1987
被引 125
人大 AFT50ABS 4

中文导读

分析按诊断相关分组(DRG)定价如何激励医院在成本较低的DRG上专业化,并探讨患者成本差异对专业化类型和控费效果的影响。

Abstract

Under the system of hospital reimbursement for Medicare patients, hospitals receive a prospectively determined price that varies according to the diagnosis related group (DRG) to which the patient is assigned. Rate-setting by DRG encourages hospitals to specialize in those DRGs for which they have relatively low production costs. This may substantially reduce aggregate hospitalization costs if specializing hospitals are efficient. If, instead, hospitals specialize by treating relatively healthier patients within each DRG, cost savings may be mitigated. The wide variation of patient-specific costs within DRGs promotes the latter kind of specialization and reduces the effectiveness of rate-setting.

诊断相关分组费率设定医院专业化患者选择