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Example research essay topic: Care Financing Health Care - 1,117 words

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... ies to 1, 263. (Edwards, et al, 1994). The DRG developed for use with Medicare has been altered for use with non-Medicare populations. In 1987, the State of New York enacted legislation mandating a PPS for all non-Medicare patients. The State Department of Health was required to assess the appropriateness of HCFA DRGs for a non-Medicare population, including a specific evaluation of the appropriateness for cases involving neonates and patients with the human immunodeficiency virus (HIV). When first implemented on January 1, 1988, the New York AP-DRGs expanded the Medicare DRG classification system to include newborn and neonate DRGs based on birth weight and ventilator dependence.

In 1990, New York refined its DRG system by the addition of a severity measure. New York developed a list of secondary diagnoses that were considered to have a major effect on resource use when present in a case. This list was based on the Yale secondary diagnoses, designated catastrophic for surgical cases and major for medical cases (Edwards, et al, 1994, pp. 48 - 49). The new system increased the number of classifications by 54.

The limitations of the Yale system were addressed by a joint research effort between 3 M/Health Information Systems (HIS) and NACHRI in an effort to overcome the inconsistencies brought about by the use of the Medicare system as a foundation for a non-Medicare population. The APR-DRGs expanded the pediatric modifications and relevant data to include: principal diagnosis, secondary diagnoses, operating room procedures, age, gender, and discharge disposition, as well as birth weight and days on a mechanical respirator for neonates. The 348 basic APR-DRGs, each with four complexity subclasses, combined with the 45 neonatal APR-DRGs, result in a total of 1, 437 APR-DRGs and were first made available on January 1, 1993 (Edwards, et al, 1994). As with the Medicare DRGs, the Yale and APR DRGs will be reviewed and calibrated on an The two most pressing alterations needed within the DRG classification system are the incorporation of severity and nursing resource indexes (Diers and Bozzo, 1997). Payment arrangements and managed care information systems are built upon information embedded in case data and suggest that measurements of nursing resources need to fit with information system requirements. Acuity systems may be of use to nurses, but not to administration or finance (McManus & Pearson, 1993, p. 86).

Weighting DRGs directly for nursing solves three problems. First is the issue of reliability of patient classification. Second, weighting directly for nurses does not increase the time factor for any participant. Finally, data can be entered immediately as nursing time associated with particular kinds of case types as DRGs into the management information system. The existing payment system can be merged and / or incorporated with the nursing data and will no longer necessitate separate systems (Diers and Bozzo, 1997). The prospective payment system utilizing DRGs has undergone a great deal of scrutiny and adaptation in the years since it was implemented in 1983.

It is a system that has proven its versatility and reliability through scores of studies and operation. The advantages in cost reduction are an ongoing process of balancing hospital resource expenditures with the evolving classification of diagnosis. The most prevalent concern is that the quality of care be maintained throughout the process of cost reduction. The move to Health Management Organizations has resulted in a decreasing reliance on the DRG system in non-Medicare cases.

It is expected that the system will continue to evolve and have major impact on the health care system. Besdine, Richard W. (1998, June). Improving health care quality by reimbursement policy. Journal of the American Geriatrics Society, 46 (6), 788. Burke, M. (1992, July). Fetter, Thompson: Inventors of DRGs Look at PPS now.

Hospitals, 66 (13), 136 - 138. Cotterill, P. , Bobula, J. , Connerton, R. (1986, April). Comparison of alternative relative weights for diagnosis-related groups. Health Care Financing Review, 7 (3), 37.

Conrad, D. A. , Omenn, G. S. (1985, November). Medicares new payment plan: A mixed blessing. Technology Review, 88, 50 - 53. Diers, D. , Bozzo, J. (1997, May).

Nursing resource definition in DRGs. Nursing Economics, 15 (3), 124 - 132. Edwards, N. , Honeman, D. , et al. (1994, December). Refinement of the medicare diagnosis-related groups to incorporate a measure of severity. Health Care Financing Review, 16 (2), 45 - 65. Kahn, K.

L. , Rubenstein, L. V. , et al. (1990, October). The effects of the DRG-based prospective payment system on quality of care for hospitalized medicare patients: An introduction to the series. The Journal of the American Medical Association, 264 (15), 1953 - 1956. McMahon, L. F. , Hayward, R.

A. , Bernard, A. M. (1992, May). APACHE-L: A new severity of illness adjuster for inpatient medical care. Medical Care, 30 (5), 445 - 452.

McManus, S. M. Pearson, J. V. (1993). Nursing at a crossroads: Managing without facts. Health Care Management Review, 18 (1), 79 - 90.

Rogowski, J. R. , Byrne, D. J. (1990, December). Comparison of alternative weight recalibration methods for diagnosis-related groups.

Health Care Financing Review, 12 (2), 87 - 102. Bibliography: VII. References Besdine, Richard W. (1998, June). Improving health care quality by reimbursement policy. Journal of the American Geriatrics Society, 46 (6), 788. Burke, M. (1992, July).

Fetter, Thompson: Inventors of DRGs Look at PPS now. Hospitals, 66 (13), 136 - 138. Cotterill, P. , Bobula, J. , Connerton, R. (1986, April). Comparison of alternative relative weights for diagnosis-related groups. Health Care Financing Review, 7 (3), 37. Conrad, D.

A. , Omenn, G. S. (1985, November). Medicares new payment plan: A mixed blessing. Technology Review, 88, 50 - 53. Diers, D. , Bozzo, J. (1997, May).

Nursing resource definition in DRGs. Nursing Economics, 15 (3), 124 - 132. Edwards, N. , Honeman, D. , et al. (1994, December). Refinement of the medicare diagnosis-related groups to incorporate a measure of severity.

Health Care Financing Review, 16 (2), 45 - 65. Page 10 Kahn, K. L. , Rubenstein, L. V. , et al. (1990, October). The effects of the DRG-based prospective payment system on quality of care for hospitalized medicare patients: An introduction to the series. The Journal of the American Medical Association, 264 (15), 1953 - 1956.

McMahon, L. F. , Hayward, R. A. , Bernard, A. M. (1992, May).

APACHE-L: A new severity of illness adjuster for inpatient medical care. Medical Care, 30 (5), 445 - 452. McManus, S. M. Pearson, J. V. (1993).

Nursing at a crossroads: Managing without facts. Health Care Management Review, 18 (1), 79 - 90. Rogowski, J. R. , Byrne, D.

J. (1990, December). Comparison of alternative weight recalibration methods for diagnosis-related groups. Health Care Financing Review, 12 (2), 87 - 102.


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Research essay sample on Care Financing Health Care

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