Relay-Version: version B 2.10 5/3/83; site utzoo.UUCP Posting-Version: version B 2.10.2 9/5/84; site aecom.UUCP Path: utzoo!watmath!clyde!burl!ulysses!allegra!mit-eddie!godot!harvard!seismo!cmcl2!philabs!aecom!werner From: werner@aecom.UUCP (Craig Werner) Newsgroups: net.med Subject: DRG/HMOs and quality of Patient Care (provocative) Message-ID: <1011@aecom.UUCP> Date: Wed, 12-Dec-84 17:11:16 EST Article-I.D.: aecom.1011 Posted: Wed Dec 12 17:11:16 1984 Date-Received: Fri, 14-Dec-84 05:53:26 EST Distribution: net Organization: Albert Einstein Coll. of Med., NY Lines: 28 In an effort to bring down the high cost of Health care, there has been a spread of HMOs (Health Maintenance Organizations) and reimbursement by DRGs (Diagnostic Related Groups). To oversimplify, these work by Pre-payment by the patient (HMO) or a set fee for the diagnosis (DRG), and replace so-called Fee for Service arrangements. (Pay for each test, pay for each day in the hospital - the more the doctor does, the more he gets paid). With the new system, reimbursement is fixed. So that if a patient requires extra care, the doctor (or Hospital) gets no extra money. So in the extreme, the most money is made by non-treatment of the patient. Incidentally, the argument for the above arrangement is that it discourages Useless tests (most of which are useful in many cases but may be superfluous or done for legal - fear of malpractice suits - reasons) and also encourages the patient to seek more health care - since it's paid for in advance, why not go for regualr checkups, etc. However, can others see the chance of the system's abuse? Especially with the rise of Health Care for Profit chains of Hospitals (i.e. Humana). Post or mail, I'd like to see this discussed. -- Craig Werner !philabs!aecom!werner What do you expect? Watermelons are out of season!