References
- 1. Fetter RB, Thompson JD, Mills RE. A system for cost and reimbursement control in hospitals. Yale J Biol Med. 1976; 49:123-36.
- 2. Roger France FH. Case mix use in 25 countries: a migration success but international comparisons failure. Int J Med Inform. 2003; 70:215-9.10.1016/S1386-5056(03)00044-3
- 3. Rosenberg MA, Browne MJ. The Impact of the Inpatient Prospective Payment System and Diagnosis- Related Groups: A Survey of the Literature. North American Actuarial Journal. 2001; 5:84-94.10.1080/10920277.2001.10596020
- 4. International Classification of Diseases (ICD). World Health Organization [Internet]. 2008 [cited 2008 Oct 12]. Available from: http://www.who.int/classifications/icd/en/.
- 5. Vladeck BC. Medicare hospital payment by diagnosisrelated groups. Ann Intern Med. 1984; 100:576-91.10.7326/0003-4819-100-4-576
- 6. Sheingold SH. The first three years of PPS: Impact on medicare costs. Health Affairs. 1989; 8:191-204.10.1377/hlthaff.8.3.191
- 7. McMahon LF, Jr., Smits HL. Can Medicare prospective payment survive the ICD-9-CM disease classification system? Ann Intern Med. 1986; 104:562-6.10.7326/0003-4819-104-4-562
- 8. Iezzoni LI. Risk adjustment for measuring healthcare outcomes. 2nd ed. Chicago, IL: Health Administration Press; 1997.
- 9. Fisher ES, Whaley FS, Krushat WM, et al. The accuracy of Medicare’s hospital claims data: progress has been made, but problems remain. Am J Public Health. 1992; 82:243-8.10.2105/AJPH.82.2.243
- 10. Iezzoni LI, Moskowitz MA. Clinical overlap among medical diagnosis-related groups. JAMA. 1986; 255: 927-9.
- 11. Lloyd SS, Rissing JP. Physician and coding errors in patient records. JAMA. 1985; 254:1330-6.
- 12. Simborg DW. DRG creep: a new hospital-acquired disease. N Engl J Med. 1981; 304:1602-4.
- 13. Psaty BM, Boineau R, Kuller LH, Luepker RV. The potential costs of upcoding for heart failure in the United States. Am J Cardiol. 1999; 84:108-9, A9.10.1016/S0002-9149(99)00205-2
- 14. Silverman E, Skinner J. Medicare Upcoding and Hospital Ownership. Journal of Health Economics. 2004; 23:369-89.10.1016/j.jhealeco.2003.09.007
- 15. Pongpirul K, Walker DG, Winch PJ, Robinson C. A qualitative study of DRG coding practice in hospitals under the Thai Universal Coverage Scheme. BMC Health Serv Res. 2011;11:71.10.1186/1472-6963-11-71
- 16. Korcok M. Will DRG payments creep into all US health insurance plans? Can Med Assoc J. 1984; 130: 912-5.
- 17. Dranove D. Rate-Setting by Diagnosis Related Groups and Hospital Specialization. RAND Journal of Economics. 1987; 18:417-27.10.2307/2555606
- 18. Farley DE, Hogan C. Case-mix specialization in the market for hospital services. Health Serv Res. 1990; 25:757-83.
- 19. Zuidema GD, Dans PE, Dunlap ED. Documentation of care and prospective payment. One hospital’s experience. Ann Surg. 1984; 199:515-21.
- 20. Gollin G, Moores D. Turning whine into wine: the fiscal impact of comprehensive documentation and billing for nonoperative pediatric surgical services. J Pediatr Surg. 2006; 41:1093-5.10.1016/j.jpedsurg.2006.02.009
- 21. Brown JG. Improper fiscal year 2000 medicare fee-forservice payments (A-17-00- 02000): Department of Health and Human Services Office of Inspector General; 2001.
- 22. Kleinmuntz C, Kleinmuntz D, Stephen R, Nordlund D. Measuring and managing risk improves strategic financial planning. Healthcare Financial Management. 1999:51-8.
- 23. Gottlieb M, Eichenwald K, Barbanel J. Health care’s giant: powerhouse under scrutiny-a special report. New York Times. 1997; 28 March;Sect. 1.
- 24. Brubaker B. HCA Faces New Fraud Charges; US Says Virginia Hospitals Involved in Medicare Scam. Washington Post 2001 17 March.
- 25. McNeil BJ. Hospital response to DRG-based prospective payment. Med Decis Making. 1985; 5: 15-21.10.1177/0272989X8500500104
- 26. Lorence DP, Richards M. Variation in coding influence across the USA. Risk and reward in reimbursement optimization. J Manag Med. 2002; 16:422-35.10.1108/02689230210450981
- 27. Williams SV. The impact of DRG-based prospective payment on clinical decision making. Med Decis Making. 1985; 5:23-9.10.1177/0272989X8500500106
- 28. Harper DL. Critical appraisal of the DRG system: problem areas for DRG reimbursement in the USA. Aust Clin Rev. 1985:5-11.
- 29. Dafny LS. How Do Hospitals Respond to Price Changes? In: National Bureau of Economic Research, Inc, NBER Working Papers: 9972; 2003.
- 30. Lave JR. Hospital reimbursement under Medicare. Milbank Mem Fund Q Health Soc 1984;62:251-68.
- 31. McCarthy CM. DRGs-five years later. N Engl J Med. 1988; 318:1683-6.
- 32. Hadley J, Swartz K. The impacts on hospital costs between 1980 and 1984 of hospital rate regulation, competition, and changes in health insurance coverage. Inquiry. 1989; 26:35-47.
- 33. Hadley J, Zuckerman S, Feder J. Profits and fiscal pressure in the prospective payment system: their impacts on hospitals. Inquiry. 1989; 26:354-65.
- 34. Russell LB, Manning CL. The effect of prospective payment on Medicare expenditures. N Engl J Med. 1989; 320:439-44.
- 35. Barbetta GP, Turati G, Zago AM. Behavioral differences between public and private not-for-profit hospitals in the Italian National Health Service. Health Econ. 2007; 16:75-96.10.1002/hec.1143
- 36. Siciliani L. Selection of treatment under prospective payment systems in the hospital sector. J Health Econ. 2006; 25:479-99.10.1016/j.jhealeco.2005.09.007
- 37. Greenberg D, Peiser JG, Peterburg Y, Pliskin JS. Reimbursement policies, incentives and disincentives to perform laparoscopic surgery in Israel. Health Policy. 2001; 56:49-63.10.1016/S0168-8510(00)00131-7
- 38. Bentley J, Butler P. Describing and paying hospitals: development in patient case mix. Washington, D.C.: Association of American Medical Colleges; 1980.
- 39. Dranove D, White WD. Medicaid-dependent hospitals and their patients: how have they fared? Health Serv Res. 1998; 33:163-85.
- 40. Malcomson JM. Supplier discretion over provision: Theory and an application to medical care. RAND Journal of Economics. 2005; 36:412-32.
- 41. Rock RC. Assuring quality of care under DRG-based prospective payment. Med Decis Making. 1985; 5: 31-4.10.1177/0272989X8500500108
- 42. Guterman S, Eggers PW, Riley G, Greene TF, Terrell SA. The first 3 years of Medicare prospective payment: an overview. Health Care Financ Rev. 1988; 9:67-77.
- 43. Wynia MK, Cummins DS, VanGeest JB, Wilson IB. Physician manipulation of reimbursement rules for patients: between a rock and a hard place. JAMA. 2000; 283:1858-65.
- 44. Powell R. Bureaucratic Malpractice. In: Princeton University, Center for the Analysis of Public Issues; 1974.
- 45. Gilman BH. Hospital response to DRG refinements: the impact of multiple reimbursement incentives on inpatient length of stay. Health Econ. 2000; 9:277-94.10.1002/1099-1050(200006)9:4<;277::AID-HEC513>3.0.CO;2-1
- 46. Sloan FA, Morrisey MA, Valvona J. Effects of the Medicare prospective payment system on hospital cost containment: an early appraisal. Milbank Q. 1988; 66:191-220.10.2307/3350030
- 47. Zhang JL. The impact of a diagnosis-related groupbased prospective payment experiment: the experience of Shanghai. Applied Economics Letters. 2010; 17: 1797-803.10.1080/13504850903317347
- 48. Newhouse JP. Do unprofitable patients face access problems? Health Care Financ Rev. 1989; 11:33-42.
- 49. Sheingold SH. The first three years of PPS: impact on Medicare costs. Health Aff (Millwood). 1989; 8: 191-204.
- 50. Steinbusch PJ, Oostenbrink JB, Zuurbier JJ, Schaepkens FJ. The risk of upcoding in casemix systems: a comparative study. Health Policy. 2007; 81: 289-99.10.1016/j.healthpol.2006.06.002
- 51. Lungen M, Lauterbach KW. [Upcoding-a risk for the use of diagnosis-related groups]. Dtsch Med Wochenschr. 2000; 125:852-6.
- 52. Victorian Government Department of Human Services. Victoria, public hospitals, policy and funding guidelines 1997-1998. Melbourne: Victorian Government Department of Human Services; 1997.
- 53. Carter GM, Newhouse JP, Relles DA. How Much Change in the Case Mix Index Is DRG Creep? Journal of Health Economics. 1990; 9:411-28.10.1016/0167-6296(90)90003-L
- 54. Carter GM, Newhouse JP, Relles DA. Has DRG Creep Crept Up? Decomposing The Case Mix Index Change Between 1987 And 1988. Santa Monica, CA: RAND Corporation; 1991.
- 55. Serden L, Lindqvist R, Rosen M. Have DRG-based prospective payment systems influenced the number of secondary diagnoses in health care administrative data? Health Policy. 2003; 65:101-7.10.1016/S0168-8510(02)00208-7
- 56. Hsia DC, Ahern CA, Ritchie BP, Moscoe LM, Krushat WM. Medicare reimbursement accuracy under the prospective payment system, 1985 to 1988. JAMA. 1992; 268:896-9.
- 57. Rovner J. Providers ‘Downcoding’ Medicare Claims to Avert Investigation. Reuters Health Information 2001.
- 58. Becker D, Kessler D, McClellan M. Detecting Medicare abuse. J Health Econ. 2005; 24:189-210.10.1016/j.jhealeco.2004.07.002
- 59. Hsia DC. Diagnosis related group coding accuracy of the peer review organizations. J AHIMA . 1992; 63: 56-64.
- 60. Boadway R, Marchand M, Sato M. An optimal contract approach to hospital financing. J Health Econ. 2004; 23:85-110. 10.1016/j.jhealeco.2003.08.001