将来の支払いシステムで緊急サービスで発生した入院の経済的効果

E Muñoz, A Laughlin, D M Regan

JAMA

|October 4, 1985

まとめ

将来の支払いシステムは,特にメディケア患者にとって,病院の財政に大きな影響を与えました. 病院は,補償額が減り,費用が増加したため,これらの制度の下でかなりの損失に直面しました.

科学分野:

健康経済学医療経済学
病院の財務管理病院の財務管理
保健医療政策について

背景:

将来の支払いシステム (PPS) は,医療費をコントロールすることを目的としています.
診断関連グループ (DRG) は,PPSの重要な構成要素です.
緊急治療室は,入院者のための重要なエントリーポイントです.

研究の目的:

PPSの下での緊急診療所の入院の財務業績を評価する.
メディケアと全給付制度の財政的成果を比較する.
病院の収入に対する特定のPPS調整の影響を分析する.

主な方法:

1983年と1984年の病院料金と緊急治療室入院費用の分析.
標準的な診断関連グループ (DRG) 方法論の適用.
メディケアと全給付制度における財務データの比較.

主要な成果:

病院は,両方の支払いシステムにおいて,費用を費用の指標として使用する際,重大な経済的損失を被った.
実際のコストを使用すると,メディケア患者は赤字となり,全給制度はわずかな利益を示した.
連邦化されたDRG料金と,アウトライヤー/授業費用の払い戻しの削減は,財政的損失を悪化させた.

結論:

緊急診療所の入院数が多い病院,特にメディケアの患者は,PPSの下で財政的な不利益に直面します.
PPSの補償構造は,緊急診療所主導の入院に伴う費用を十分にカバーできない可能性があります.
大規模なメディケア人口にサービスを提供している病院の財政的持続可能性を確保するために,PPSへの政策調整が必要である.

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