Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

For now, some insurers will pay for the procedure as if it had been approved, but others will pay nothing. Insurers say the day is coming when denial of payment will be far more common ( Kramon, 1991). Ultimately, an uneasy balance must be struck between government and health positions. The use of DRGs is, for all its limitations and biases, an important first step to nationalizing health care.


REFERENCES

Barnard C. and T. Esmond. 1981. "DRG Based Reimbursement: The Use of Concurrent and Retrospective Clinical Data." Medical Care 19(11):1071-82.

Bush George. 1988. "Campaign 88: More Efficient Health Care Delivery Needed." Modern Health Care 18(20), May 13.

Cole L. A. 1984. "Public Policy on Health Care and the Attitudes of Practitioners: The Case of Dentistry." Paper presented at 1984 Annual Meeting American Political Science Association. Washington, DC, August.

Egan Timothy. 1991. "Oregon Shapes Up Pioneering Health Plan for the Poor." New York Times, February 22: A12.

Fuangchen S. N. and D. P. McCaffrey. 1984. "The Impact of Certificate of Need and Rate Setting Regulation on Complex Medical Technology, A Nine Year Evaluation." Paper presented at IASIA Conference. Bloomington, Indiana, July.

Hughes K. E., H. L. Daley, and W. M. Patterson. 1983. "Predicting Acute Care Hospital Bed Use Through Physician Inpatient Activity Modeling: First Steps." Health Care Strategy Management 1(1):8-11.

Kramon Glen. 1991. "Medical Second Guessing in Advance." New York Times, February 24:12.

Marty J., L. Bridges, and Philip Jacobs. 1986. "Obtaining Estimates of Marginal Cost by DRG." Health Care Management, October: 40-46.

Maurer Robert. 1987. "The DRG System: An Exercise in Illogic and Frustration." Osteopathic Hospital Leadership 1(6):20.

McMahon L. F., Jr. 1984. "Diagnosis Related Groups Prospective Payment." Evaluation and the Health Provisions 7:25-41.

Mehra Satish. 1986. "Prospective Pricing System: DRGs and Their Impact on Health Care Operations." Journal of Health and Human Resources Medicine 9(2):232-45.

Molotsky Irvin. 1984. "Study Urges Use of Health Aides." New York Times, May 6:35.

Morone James A. 1985. "The Politics of DRGS: New Jersey to New Hampshire." Unpublished paper presented at Seton Hall Conference.

Olsen S. M. 1984. "The Challenge of Prospective Pricing: Work Smarter." Journal of Nursing Administration. 14(4):22-26.

Reilly B. J. and J. S. Legge. 1982. "The Embattled Hospital Care Control Measures versus Imperatives for Expansion." Journal of Health Politics Policy and Law 7(1):254-70.

Rhode Island Medical Journal. 1987. Editorial 70:203-4.

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