Per case hospital payment systems are based on the concept of averaging. In recent years however instances have been identified in which these averaging assumptions do not apply. For example, inner city and teaching hospitals care for a more severely ill population than is recognised by the DRG measure of case mix. Several medical and surgical procedures have been identified in which hospitals had an incentive to specialize because the DRG classification system placed them in categories for which payments exceeded average costs. Similarly the article identifies patient categories which consume more services and cost more than other patients classified in the same DRG category. The article makes the case for adjustments in per-case payments to ensure that neither the access to care of particular categories nor the financial well-being of hospitals are jeopardized.
ASJC Scopus subject areas
- Internal Medicine