The debate over diagnosis related groups.
ABSTRACT With the advent of the Prospective Payment System (PPS) using Diagnosis Related Groups (DRGs) as a classification method, the pros and cons of that mechanism have been sharply debated. Grouping the comments into categories related to administration/management, DRG system and quality of care, a review of relevant literature highlights the pertinent attitudes and views of professionals and organizations. Points constantly argued include data utilization, meaningful medical classifications, resource use, gaming, profit centers, patient homogeneity, severity of illness, length of stay, technology limitations and the erosion of standards.
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ABSTRACT: In an effort to control rampant hospital-cost inflation, Congress passed the Tax Equity and Fiscal Responsibility Act of 1982 and the Social Security Amendments of 1983. The result of these two initiatives is the implementation of a prospective payment system (PPS) that uses diagnosis related groups (DRGs) in classifying patients and reimbursing hospitals for Medicare patients. Using the Health Care Financing Adminstration's (HCFA) meth on the average the typical naval hospital would have been reimbursed 32 percent more than actual inpatient expenses had it been reimbursed under Medicare.
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ABSTRACT: The major trends in the growth of prospective payment and the corporatization of medical practice in the United States are examined. In particular, the ethical implications of these changes in the context of the multiple system goals of access, cost containment, and quality are considered. Considerable concern is being expressed that with the dominant emphasis on cost containment, the principles of access and quality might be compromised. This paper formulates a research agenda to address this question, based on a review and synthesis of empirical evidence and hypotheses about the probable or actual impact of these changes on the multiple health system goals. A basic premise is that ethical judgments should be grounded in empirical evidence about what actually is or will be.Social Justice Research 01/1987; 1(3):275-296. DOI:10.1007/BF01047664 · 0.89 Impact Factor
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ABSTRACT: El objetivo general de este trabajo es el de ofrecer un perfil completo de los or�genes, la evoluci�n y el multiforme desarrollo de la historia de la contabilidad en Espa�a, as� como de su posible evoluci�n futura. Haciendo referencia a las actividades cient�ficas y a los estudios m�s recientes se ha intentado mostrar el notable grado de desarrollo alcanzado por esta disciplina, gracias entre otras cosas a la sinergia lograda por la colaboraci�n entre las instituciones acad�micas y las organizaciones profesionales, una caracter�stica particular de la experiencia espa�ola. Inserto en un cuadro de s�ntesis general, se ofrece el relato de esta experiencia, que ha conseguido situar la historia de la contabilidad espa�ola y sus representantes en el primer lugar del concierto europeo. The general purpose of this paper is to offer a complete profile of the origins, the evolution and the multiform development of accounting history in Spain, as well as the possible directions of its future evolution. Making reference to the scientific activities and the most recent studies it has been tried to show the remarkable degree of development reached by this discipline, thanks among other things to the synergy obtained by the collaboration between the academic institutions and the professional organizations, a particular characteristic of the Spanish experience. Inserted in a general picture of synthesis, this paper offers an account of this experience, an experience that has been able to locate the Spanish accounting history and its representatives in the first place of the European environment.Accounting Organizations and Society 01/1992; 17(1):63-100. DOI:10.1016/0361-3682(92)90036-R · 2.88 Impact Factor