medicare DRG和tw DRG如出一轍，美國hospitalist的困境，何謂POA, HAC?

http://www.medscape.com/viewarticle/724087

https://docs.google.com/fileview?id=0B278nGJMQBk7Y2I2NTZlYmYtOGM2YS00MWY0LWI2NTEtNDgyZWVkNzA0OTE3&hl=zh_TW

美國國會希望medicare是pay for quality,而非pay for quandity
所以做DRG，不付HACs(hospital acquired complications)所以hospitalist在一開始接病人時
就要找出POA(condition present on admission)，病歷書寫至為重要，不然拿不到錢，要想辦法證明自己無罪…(跟台灣怎麼這麼像，要和健保局/法院證明自己無罪，只好像護理系統一樣，文書越來越多，沒空看病人)

他們不太了解，Something just not preventable, blame it to somebody is simple, 簡化加扭曲事情的本質而已
文章裏舉DVT為例
在這裏，老人住院是第一個保齡球瓶倒，明知第一個球瓶倒後面會跟著倒，但健保認為後面的球瓶倒是你幹的你要負責，這是胡搞瞎搞
這些公衛蛋頭copy美國，又嘲笑美國保險制度，全付精力用在壓醫界，一點原創性也沒有，領薪水不知在幹嘛?
好，說我沒醫德，at least i do my job well

神經病一堆!!

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