Abstract

Medicare currently uses a financing system called the Diagnostic Related Groups which prospectively determines the amount of allowable costs for hospital care and treatment by the disease of the patient at the time of hospital admission. Medical DRGs, then, assume that once a patient is diagnosed with a disease, the treatment required and prognosis are predictable events. This analysis questions whether the DRGs make sense, given what is known in medical science. ;The philosophies of Aristotle and Bernard Lonergan form the backdrop against which modern medical understanding is compared to the ancient practice of medicine. Both ancient and contemporary medicine entail the quandary, Can disease concepts capture and provide the knowledge necessary for treating individual patients? This question is interwoven with the debate over whether medicine is an art or a science, and the position taken in this paper is that art and science are most often improperly conceptualized by the medical community. The distinction should thus be avoided. ;The concept of disease--the centerpiece and main scientific construct in the medical world--is explored, including its classification, scope, ontology, and etiology. Disease categories are initially derived from clinical experience, i.e. medical theory flows from the practice of medicine, with nonclinical scientists and public health experts also playing a critical role in furthering knowledge about diseases. Nevertheless, medical theory returns to the clinic where medical determinations of diagnosis, treatment, and prognosis occur. We find in each of these acts the presence of an element of contingence and uncertainty, or an absence of truly conclusive science. ;The implicit premises of the DRGs are revealed to be epistemologically inconsistent with actual medical understanding. Medicine would do well to focus more closely on the Hippocratic emphasis of the individual patient rather than to stake out claims based on the disembodied disease categories. Furthermore, a greater attention to an understanding of "health" would lead to a clearer depiction of both what is known and what is as yet unknown in medicine