未来支付系统中的一天入院手术计划:金融激励是什么?
Fabian Grass1, Matthias Roth-Kleiner2, Nicolas Demartines1,3
1Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.
Health services insights
|January 22, 2024
概括
一日入院手术 (DAS) 可以降低医院费用,但可能会降低未来支付系统的报销. 仔细选择患者和调整工作流程对于DAS计划的财务可行性至关重要.
科学领域:
- 医疗保健经济学 医疗保健经济学
- 手术操作管理手术操作管理
背景情况:
- 一日住院手术 (DAS) 旨在通过尽量减少住院时间来改善患者体验并降低医院费用.
- 未来的支付系统 (PPS) 可能会为实施DAS的医院带来财务阻碍,因为退款减少了.
研究的目的:
- 分析DAS对瑞士诊断相关集团 (SwissDRG) 未来支付系统中的医院收入的财务影响.
- 将DAS产生的收入与传统的手术前入院 (没有DAS) 进行比较,并估计成本节省.
主要方法:
- 一项为期4个月的前性研究 (2021年) 涉及来自各种外科子专业的患者接受DAS.
- 在瑞士DRG政策下,收入分析比较DAS和没有DAS的场景.
- 微成本计算方法,以估计避免手术前住院的成本节约.
主要成果:
- 105名患者接受了DAS,产生了1,209,840瑞士法郎的收入.
- 24%的DAS患者是财务异常值,平均折扣为4192瑞士法郎.
- 达斯的平均收入为7320瑞士法郎,远低于没有达斯的11510瑞士法郎 (P=.007).
结论:
- 在PPS中实施DAS需要预见财务处罚,特别是没有严格的患者选择标准,以保持财务平衡.
- 医院应该修改工作流程,以有效地管理DAS下的更大患者数量的固定成本,以减轻财务风险.
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