The Need for Diagnosis-Related Group 471

TODAY we face a crisis in clinical research that demands that attention be directed to a problem that physicians have not had to worry about in the past: the impact of reimbursement for patient care on the progress of medical science. Until this year, the costs for patients involved in clinical trials were paid in two ways: the research costs of data collection and analysis, experimental drugs, and such were paid by research grants; the patient-care costs were paid by the patient or the insurance carrier. The advent of the prospective payment system and diagnosis-related group (DRG) reimbursement dramatically alters this system and changes the incentives. Under the DRG system, the hospital receives a fee fixed by diagnosis, and administrators are likely to show little enthusiasm for anything that increases the cost of care. Extra laboratory tests or x-ray films beyond a bare minimum will not be encouraged. The pattern