概括
在医疗和外科专业之间,医生补偿费率每小时并没有实质性的差异. 基于资源的相对价值表 (RBRVS) 和医疗保险费用表不适合改革医生补偿.
科学领域:
- 卫生经济学 卫生经济学
- 医疗政策 医疗政策
- 医生补偿金 医生补偿金
背景情况:
- 有一种看法是,程序医疗服务的报销率高于认知服务.
- 国会授权医疗保健融资管理局 (HCFA) 制定医疗保险费用表,将资金从程序服务转移到认知服务.
- 一个基于资源的相对价值尺度 (RBRVS) 被开发出来,为此转变提供了一个合理的基础,通过将服务价值等同于必要的资源.
研究的目的:
- 用标准的商业/工业方法 (收入除以劳动时间) 评估医生补偿率.
- 根据拟议的支付系统,包括RBRVS和HCFA费用表,重新计算退款率.
- 评估RBRVS和HCFA费用表作为医生报销改革的基础的适当性.
主要方法:
- 分析了使用独立数据源对15个医学和外科专业的收入和专业工作时间.
- 采用标准的商业/工业方法来确定补偿率 (收入/劳动时间).
- 从哈佛-Hsiao RBRVS和HCFA费用表中利用预测的收入变化来重新计算报销率.
主要成果:
- 医疗 (33.90美元) 和外科 (38.80美元) 专业的平均每小时报销率并没有显著差异.
- 专业之间的年收入差异主要是由外科医生的每周额外工作时间 (17.2小时多) 解释的.
- 拟议的RBRVS和HCFA支付系统均等收入,但不承认工作时间,培训或工作差异.
结论:
- RBRVS和HCFA的费用表是改革医生补偿制度的不合适基础.
- 对于程序服务的更高补偿的看法可能源于计费方法,而不是实际的小时费率.
- 报销改革应该考虑资源分配以外的因素,例如实际的工作量和培训.
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