Payment policy in the United States since the introduction of the Medicare Program for the elderly and disabled populations in the 1960s has been evolving from providing little incentive for hospitals to contain costs to its current form, which creates an enormous incentive for cost containment. The Diagnosis Related Group (DRG) system implemented by Medicare for hospital payment in 1983 is vie...

Background At present, the diagnosis-related groups-based prospective payment system (DRG-PPS) that has been implemented in China is merely a prototype called the simplified DRG-PPS, which is known as the 'ceiling price for a single disease'. Given that studies on the effects of a simplified DRG-PPS in China have usually been controversial, we aim to synthesize evidence examining whether DRGs c...

BACKGROUND AND PURPOSE Endovascular and surgical options are both available for treatment of ruptured cerebral aneurysms. Knowledge of the costs relative to Medicare reimbursement for hospitalization of these patients is important for understanding the economic impact of these patients on hospitals. MATERIALS AND METHODS Using the NIS, we identified hospitalizations for clipping and coiling o...

PURPOSE As several years have passed since the implementation of the Korean diagnosis-related group (DRG) payment system for appendicitis, its early outcomes should be assessed to determine if further improvements are warranted. METHODS We retrospectively analyzed clinical data from Korean patients who underwent appendectomy, dividing the sample into 2 groups of those who received services be...

Background In 2003 Germany started to replace its per-day hospital payment system by a prospective payment system based on diagnosis related groups (DRG). The primary objective of the program was to increase economic efficiency of hospital care. The introduction was accompanied by fears that quality of care could deteriorate when hospitals withhold necessary care in order to increase profits. O...

This study shows that, contrary to popular belief, the prospective payment system discourages skimping on medically indicated care. The quality of care on a nationally representative sample of Medicare discharges underwent judgmental review using implicit criteria. The reviewing physicians identified hospitalizations that omitted medically indicated services and diagnoses overlooked because of ...

On October 1, 2013 the reporting of diagnoses and procedures in the U.S. will transition from the clinical modification of the ninth revision of the International Classification of Diseases (ICD-9-CM) to the tenth revision (ICD-10). The impact of conversion to ICD-10 on Medicare MS-DRG payments to hospitals was estimated using 2009 Medicare data. A minimal hospital payment increase of 0.05 perc...

Prospective payment rates based on Diagnosis Related Groups (DRGs) have been established as the basis of Medicare’s hospital reimbursement system. The DRGs are a patient classification scheme which provides a means of relating the type of patients a hospital treats (i.e., its case mix) to the costs incurred by the hospital. The design and development of the DRGs began in the late sixties at Yal...

Malnutrition is a prevalent condition affecting 30-50% of hospitalized patients. linked to impairments in health outcomes and increased economic burden on healthcare systems. We assessed the prevalence malnutrition by examining demographic characteristics, Disease Related Group (DRG) payments associated claims among Medicare inpatients (65+ years) with without COVID-19. Hospital inpatient COVID...