Table 8. Exclusions From DRG System.
| Type of Case | BCBSA Products | Medicaid Plans | ||||
|---|---|---|---|---|---|---|
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|
|
|||||
| Number of Products | Percent Excluded | Number of Plans | Percent Excluded | |||
|
|
|
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| Excluded | Included | Excluded | Included | |||
| Hospital | ||||||
| Small Rural | 50 | 39 | 56 | 3 | 18 | 14 |
| Psychiatric | 82 | 10 | 89 | 16 | 5 | 76 |
| Pediatric | 37 | 38 | 49 | 7 | 14 | 33 |
| Rehabilitation | 12 | NA | NA | 12 | 9 | 57 |
| Unit | ||||||
| Psychiatric | 59 | 32 | 65 | 10 | 11 | 48 |
| Pediatric | 15 | 75 | 17 | — | — | — |
| Rehabilitation | 57 | 34 | 63 | 13 | 8 | 62 |
| Intensive Care | 15 | 75 | 17 | — | — | — |
| Perinatal | NA | NA | NA | 2 | 19 | 10 |
| Substance Abuse | NA | NA | NA | 3 | 18 | 14 |
NOTES: BCBSA is Blue Cross and Blue Shield Association. NA is not available.
SOURCE: Carter, G.M., Jacobson, P.D., Kominski, G.F., and Perry, M.J., RAND, 1994.