A System for Cost and Reimbursement Control in Hospitals.

Abstract

This paper approaches the design of a regional or statewide hospital rate-setting system as the underpinning of a larger system which permits a regulatory agency to satisfy the requirements of various public laws now on the books or in process. It aims to generate valid interinstitutional monitoring on the three parameters of cost, utilization, and quality review. Such an approach requires the extension of the usual departmental cost and budgeting system to include consideration of the mix of patients treated and the utilization of various resources, including patient days, in the treatment of these patients. A sampling framework for the application of process-based quality studies and the generation of selected performance measurements is also included.

Congenital heart disease: interrelation between German diagnosis-related groups system and Aristotle complexity score

“…The Disease-Related Group (DRG) system was initially developed, as of 1975, by Fetter [1] of Yale University. Germany adopted it in 2000, choosing and modifying the Australian DRG version.…”

A realistic evaluation of fines for hospital discharges: Incorporating the history of programme evaluations in the analysis

“…The theory of linking financial incentives to performance indicators builds on the economic theory of 'change the financial reward and the behaviour will be changed' (Fetter et al, 1976). Although 'delayed discharges' is a performance indicator managed by financial incentives, it is also embedded in a group of other performance indicators which are managed by another tool for target compliance: public reporting.…”

Casemix classification systems

“…Although DRGs were created to serve managers as a tool in running hospitals, the Federal Government, seeing the potential of prospective payment schemes in better understanding and restraining soaring health care costs, supported DRG research, and we directed our efforts simultaneously at cost and reimbursement control (Fetter, Thompson & Mills 1976). …”