In response to the rising costs of health care, Congress initiated a dramatically new payment system for Medicare as part of the Social Security Amendments of 1983.1,2 It is anticipated that the shift from retrospective cost-based reimbursement for inpatient care to prospective payment on the basis of 467 diagnosis-related groups (DRGs) will significantly decrease hospital costs by fundamentally altering the incentives, and thus the behavior, of hospitals and physicians.3 These revolutionary changes will permeate all areas of medicine. Unfortunately, not all of the intended and unintended side effects of this change have been examined fully. Particularly unexamined have been the potential effects of these changes on clinical research, especially clinical research in psychiatry.
Several authorities have drawn attention to the generic issues surrounding DRGs and clinical research. Heyssel4 has warned that the functions that academic health centers perform in research and education are in considerable danger of