PMID- 10142368
OWN - NLM
STAT- MEDLINE
DCOM- 19950630
LR  - 20181130
IS  - 0195-8631 (Print)
IS  - 1554-9887 (Electronic)
IS  - 0195-8631 (Linking)
VI  - 16
IP  - 2
DP  - 1994 Winter
TI  - Use of diagnosis-related groups by non-Medicare payers.
PG  - 127-58
AB  - Medicare's prospective payment system (PPS) for hospital cases is based on 
      diagnosis-related groups (DRGs). A wide variety of other third-party payers for 
      hospital care have adapted elements of this system for their own use. The extent 
      of DRG use varies considerably both by type of payer and by geographical area. 
      Users include: 21 State Medicaid programs, 3 workers' compensation systems, the 
      Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), more 
      than one-half of the Blue Cross and Blue Shield Association (BCBSA) member plans, 
      several self-insured employers, and a few employer coalitions. We describe how 
      each of these payers use DRGs. No single approach is dominant. Some payers 
      negotiate specific prices for so many combinations of DRG and hospital that the 
      paradigm that payment equals rate times weight does not apply. What has emerged 
      appears to be a very flexible payment system in which the only constant is the 
      use of DRGs as a measure of output.
FAU - Carter, G M
AU  - Carter GM
AD  - RAND, Santa Monica, CA 90407, USA.
FAU - Jacobson, P D
AU  - Jacobson PD
FAU - Kominski, G F
AU  - Kominski GF
FAU - Perry, M J
AU  - Perry MJ
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Health Care Financ Rev
JT  - Health care financing review
JID - 7909994
MH  - Data Collection
MH  - Diagnosis-Related Groups/economics/*statistics & numerical data
MH  - Health Benefit Plans, Employee
MH  - Health Services Research
MH  - Insurance Carriers/*trends
MH  - Insurance, Hospitalization/standards/*trends
MH  - Managed Care Programs
MH  - Medicaid
MH  - Models, Organizational
MH  - Prospective Payment System/*statistics & numerical data
MH  - Rate Setting and Review/methods
MH  - United States
MH  - Workers' Compensation
PMC - PMC4193495
EDAT- 1994/12/04 00:00
MHDA- 1994/12/04 00:01
PMCR- 1994/12/01
CRDT- 1994/12/04 00:00
PHST- 1994/12/04 00:00 [pubmed]
PHST- 1994/12/04 00:01 [medline]
PHST- 1994/12/04 00:00 [entrez]
PHST- 1994/12/01 00:00 [pmc-release]
AID - hcfr-16-2-127 [pii]
PST - ppublish
SO  - Health Care Financ Rev. 1994 Winter;16(2):127-58.