Some thoughts on health and healthcare

1. Introduction Major Diagnostic Categories (MDCs) and Diagnosis-Related Groups (DRGs) underpin prospective (case-based) payment by assigning inpatient stays to clinically coherent groups and paying a predetermined amount based largely on a relative weight (resource intensity) multiplied by a standardized/base rate, with further policy adjustments (e.g., wage index, teaching, disproportionate share, outliers). Under Medicare’s Inpatient Prospective Payment System (IPPS), for example, the US  Office of Inspector General (OIG) in the USA describes the operational payment logic as “DRG weight × standardized amount,” with additional adjustments layered onto the base payment. Prospective payment improves cost discipline, but it also creates predictable gaming surfaces: when revenue depends on coded diagnoses/procedures and discharge status, some actors can increase payment by manipulating codes, fragmenting bills, or selecting “profitable” patients (cherry picking/lemon dropping). The ...

Introduction Diagnosis-Related Group (DRG) payment systems depend on relative weights that approximate the average resource intensity of clinically coherent inpatient groups. When weights are weak - because costing is inconsistent, feeds are incomplete, or coding is unreliable - national tariffs can misprice care, destabilize provider incentives, and reduce confidence in performance analytics. In this essay I try to  synthesize established approaches to patient-level costing (PLICS/ABC/TDABC) and DRG tariff setting, drawing on documented national programs (e.g., England’s National Cost Collection, Australia’s AHPCS/NEP process, and Germany’s InEK cost accounting scheme), and propose an implementable framework to (1) produce reliable national reimbursement weights, (2) embed auditability via a practical controls checklist (General Ledger (GL)  reconciliation, feed completeness, allocation governance, coding QA/QC), and (3) operationalize patient-level costs for internal hospita...