弱势,残疾,贫困和非常老的医疗保险受益人是否有更高的医院费用?
JAMA
|January 9, 1987
概括
对大多数医疗保险患者来说,诊断相关组 (DRG) 的支付似乎是公平的. 患者的特征,如残疾或养老院入院,对收费的影响很小,这表明DRG调整基本上是不必要的.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 医疗账单计费 医疗账单计费
背景情况:
- 诊断相关组 (DRG) 是医疗保险退款的关键组成部分.
- 如果患者的特征在DRG中显著改变医疗保健成本,则存在违约支付的可能性.
研究的目的:
- 评估基于诊断相关群体 (DRG) 的医疗保险支付是否会导致特定患者群体的错误支付.
- 检查患者特征与每次住院医疗保险费用总额之间的关系.
主要方法:
- 分析医疗保险每次住院费用的总费用.
- 包括八个受益人特征 (例如,入住养老院,年龄,医疗补助入学,残疾).
- 医院和分配的DRG的统计控制.
主要成果:
- 观察到费用的微小变化:残疾受益人 (6.7%) 和养老院入院 (6.2%) 的费用较高.
- 对于双重符合条件的医疗保险-医疗补助受益人来说,费用略低 (1.5%).
- 与年龄相关的费用差异很小 (例如,80岁以上的费用比80岁以上的费用高3.8%).
结论:
- 根据患者特征观察到的费用差异相对于DRG内部的变化很小.
- 将这些特征纳入DRG分类中只会带来微不足道的改善.
- 目前基于DRG的医疗保险支付表明,这些患者因素之间存在相当大的公平性.
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