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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!