Assignment: DRG-based payment system

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Discuss (in about 2-3 pages) the advantage and disadvantage of the following hospital payment systems on cost containment and provider behavior:

Fee-for-service

Per diem

The DRG-based payment system (i.e., Medicare’s Inpatient Prospective Payment System)

Capitation

Part II – Paying for Physician Services

Using the background materials and the information you find from the literature and on the Internet, respond (in about 2-3 pages) to the following questions:

1. Discuss the difference in Medicare payment methods for outpatient services and physician services.

2. Discuss the difference between bundled payments and global payments.

Describe the ethnic minority group selected. Describe the current health status of this group. How do race and ethnicity influence health for this group?
What are the health disparities that exist for this group? What are the nutritional challenges for this group?
Discuss the barriers to health for this group resulting from culture, socioeconomics, education, and sociopolitical factors.
What health promotion activities are often practiced by this group?
Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective in a care plan given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice.

Abstract

Countries in Asia are working towards achieving universal health coverage while ensuring improved quality of care. One element is controlling hospital costs through payment reforms. In this paper we review experiences in using Diagnosis Related Groups (DRG) based hospital payments in three Asian countries and ask if there is an “Asian way to DRGs”. We focus first on technical issues and follow with a discussion of implementation challenges and policy questions. We reviewed the literature and worked as an expert team to investigate existing documentation from Japan, Republic of Korea, and Thailand. We reviewed the design of case-based payment systems, their experience with implementation, evidence about impact on service delivery, and lessons drawn for the Asian region. We found that countries must first establish adequate infrastructure, human resource capacity and information management systems. Capping of volumes and prices is sometimes essential along with a high degree of hospital autonomy. Rather than introduce a complete classification system in one stroke, these countries have phased in DRGs, in some cases with hospitals volunteering to participate as a first step (Korea), and in others using a blend of different units for hospital payment, including length of stay, and fee-for-service (Japan). Case-based payment systems are not a panacea. Their value is dependent on their design and implementation and the capacity of the health system.

Assignment: DRG-based payment system