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February 12, 1982, Vol 247, No. 6 >
ARTICLE | February 12, 1982

Medical Practice, Case Mix, and Cost Containment: Title and subTitle BreakA New Role for the Attending Physician FREE

David W. Young, DBA; Richard B. Saltman, PhD
[+] Author Affiliations

Reprint requests to the Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (Dr Young).


JAMA. 1982;247(6):801-805. doi:10.1001/jama.1982.03320310049028
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References

Present political pressures for hospital cost containment appear to make some form of case-specific reimbursement system inevitable. For such a system to be able to control hospital costs effectively, however, its design must reflect the fundamental and traditional principles of management control systems. Although the diagnostic-related group (DRG) approach is the most frequently discussed form of case-mix-sensitive reimbursement, DRGs do not satisfy basic management control principles. Under a more appropriate hospital control system, however, physicians would be incorporated directly into the hospital's management structure. Consequently, to ensure that this new control system is medically as well as financially appropriate, physicians should seize the initiative in determining the standards against which their performance will be measured.

(JAMA 1982;247:801-805)

REFERENCES

1 +
 National health expenditures and related resources, Table A-1, national health expenditures by type of expenditure . Health Care Financing Trends 1981;;2:2.
2 +
Thompson JD, Fetter RB, Mross CD:  Case mix and resource use . Inquiry 1975;;12:300-312.
3 +
Mills R, Fetter RB, Riedel DC, et al:  AUTOGRP: An interactive computer system for the analysis of health care data . Med Care 1976;;14:603-615.
4 +
Evans RD:  Behavioral cost functions for hospitals . Can J Econ 1972;;5:398-418.
5 +
Feldstein MS:  Hospital cost variation and case-mix differences . Med Care 1965;;3:95-103.
6 +
Lave JR, Lave LB, Silverman LP:  Hospital cost estimation controlling for case-mix . Appl Econ 1972;;4:165-180.
7 +
Averill RF: The Application of Case Mix Cost Accounting to Hospital Budgeting and Prospective Reimbursement . New Haven, Conn, New Haven Center for the Study of Health Services, Institution for Social and Policy Studies, Yale University, 1978;.
8 +
Mechanic D: Future Issues in Health Care: Social Policy and the Rationing of Medical Services . New York, Free Press, 1980;.
9 +
Engel GV:  The effect of bureaucracy on the professional autonomy of the physician . J Health Soc Behav 1969;;10:30-41.
10 +
Green S:  Professional/bureaucratic conflict: The case of the medical profession in the National Health Service . Sociological Rev 1975;; 23:121-141.
11 +
Young DW: The Managerial Process in Human Service Agencies . New York, Praeger Publishers, 1979;.
12 +
Saltman RB, Young DW:  The hospital power equilibrium: An alternative approach to the cost containment dilemma . J Health Polit Policy Law 1981;;6:391-418.
13 +
Doremus HD:  DRGs may be raising false expectations . Hospitals 1980;;54:47-51.
14 +
Lave JR, Lave LB:  The extent of role differentiation among hospitals . Health Serv Res 1971;;6:15-38.
15 +
Lave JR, Leinhardt S:  The cost and length of a hospital stay . Inquiry 1976;;13:327-343.
16 +
Feldstein MS, Schuttinga J:  Hospital costs in Massachusetts: A methodological study . Inquiry 1977;;14:22-31.
17 +
Kaplan SX:  Private sector shows how to cut health care costs . HCFA Forum 1980;;4:2-7.
18 +
Carnoy J, Coffee L, Koo L:  Corporate medicine: The Kaiser health plan , in Kotelchuck D: Prognosis Negative: Crisis in the Health Care System . New York, Vintage Books, 1976;, pp 363-386.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
 National health expenditures and related resources, Table A-1, national health expenditures by type of expenditure . Health Care Financing Trends 1981;;2:2.
2 +
Thompson JD, Fetter RB, Mross CD:  Case mix and resource use . Inquiry 1975;;12:300-312.
3 +
Mills R, Fetter RB, Riedel DC, et al:  AUTOGRP: An interactive computer system for the analysis of health care data . Med Care 1976;;14:603-615.
4 +
Evans RD:  Behavioral cost functions for hospitals . Can J Econ 1972;;5:398-418.
5 +
Feldstein MS:  Hospital cost variation and case-mix differences . Med Care 1965;;3:95-103.
6 +
Lave JR, Lave LB, Silverman LP:  Hospital cost estimation controlling for case-mix . Appl Econ 1972;;4:165-180.
7 +
Averill RF: The Application of Case Mix Cost Accounting to Hospital Budgeting and Prospective Reimbursement . New Haven, Conn, New Haven Center for the Study of Health Services, Institution for Social and Policy Studies, Yale University, 1978;.
8 +
Mechanic D: Future Issues in Health Care: Social Policy and the Rationing of Medical Services . New York, Free Press, 1980;.
9 +
Engel GV:  The effect of bureaucracy on the professional autonomy of the physician . J Health Soc Behav 1969;;10:30-41.
10 +
Green S:  Professional/bureaucratic conflict: The case of the medical profession in the National Health Service . Sociological Rev 1975;; 23:121-141.
11 +
Young DW: The Managerial Process in Human Service Agencies . New York, Praeger Publishers, 1979;.
12 +
Saltman RB, Young DW:  The hospital power equilibrium: An alternative approach to the cost containment dilemma . J Health Polit Policy Law 1981;;6:391-418.
13 +
Doremus HD:  DRGs may be raising false expectations . Hospitals 1980;;54:47-51.
14 +
Lave JR, Lave LB:  The extent of role differentiation among hospitals . Health Serv Res 1971;;6:15-38.
15 +
Lave JR, Leinhardt S:  The cost and length of a hospital stay . Inquiry 1976;;13:327-343.
16 +
Feldstein MS, Schuttinga J:  Hospital costs in Massachusetts: A methodological study . Inquiry 1977;;14:22-31.
17 +
Kaplan SX:  Private sector shows how to cut health care costs . HCFA Forum 1980;;4:2-7.
18 +
Carnoy J, Coffee L, Koo L:  Corporate medicine: The Kaiser health plan , in Kotelchuck D: Prognosis Negative: Crisis in the Health Care System . New York, Vintage Books, 1976;, pp 363-386.

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