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Priorizando los recursos hospitalarios de Oregón. Un ejemplo basado en variaciones en la utilización médica
E S Fisher1, H G Welch, J E Wennberg
1Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH 03755-3862.
JAMA
|April 8, 1992
Resumen
Este estudio sugiere priorizar los recursos hospitalarios para las admisiones médicas discrecionales basadas en la capacidad local, ofreciendo una alternativa a Oregon.
Área de la Ciencia:
- Servicios de salud Servicios de salud Investigación Investigación.
- Economía de la salud Economía de la salud
- Política de salud pública Política de salud pública.
Sus antecedentes:
- El enfoque de racionamiento de la atención médica de Oregon se centró en tratamientos específicos.
- Existe la necesidad de estrategias alternativas de asignación de recursos en el cuidado de la salud.
Objetivo del estudio:
- Proponer un modelo de priorización de la atención médica basado en los recursos hospitalarios locales para los ingresos médicos discrecionales.
- Evaluar los ahorros potenciales de costos de este enfoque basado en recursos.
Principales métodos:
- Análisis de los datos de 1988 de alta hospitalaria de Oregón para admisiones médicas discrecionales.
- Cálculo de los días de hospitalización per cápita ajustados por edad y sexo por área de servicio hospitalario.
- Determinación de ahorros potenciales mediante la fijación de tasas máximas basadas en la utilización prevaleciente.
Principales resultados:
- Las tasas de admisión médica discrecional variaron significativamente en las áreas de servicio hospitalario de Oregon.
- Los ahorros anuales potenciales oscilaron entre 0,4 millones y 94,7 millones de dólares.
- Usar la tasa de Salem como techo podría ahorrar un estimado de $ 47.3 millones y cerrar 238 camas.
Conclusiones:
- Los recursos hospitalarios asignados a admisiones discrecionales en áreas de alto uso ofrecen una fuente significativa de reasignación.
- La limitación de las unidades de suministro de atención médica (camas, equipos, médicos) es una opción viable para la reasignación de recursos.
- Este modelo ofrece una alternativa al racionamiento específico del tratamiento.
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