ABSTRACT
This chapter considers the effect of Diagnosis Related Groups (DRGs) on access and quality of care issues. Concern about costs in the health-care system, especially for the elderly and disabled covered under Medicare, stimulated major cost containment efforts in the 1980s. The prospective payment system based on DRGs was proposed in 1983 and implemented in 1984. The DRG-based prospective payment system (PPS) is a cost-containment effort directed toward one delivery site—the acute care hospital. Clearly, DRGs as the basis for the PPS have resulted in decreased admissions and length of hospital stay. Cost shifting is an example of a strategy that influences the quality of care and places patients in jeopardy. Cost shifting occurs when care for one group of patients is reimbursed at rates below the provider estimate of the cost of that care. Many studies have focused on medication calculation errors. The identification of medication errors is an example. Errors and accidents are tracked largely through incident reports.
