Fiedler J L, Wight J B, Schmidt R M
Social Sectors Development Strategies, Sturgeon Bay, WI 54235, USA.
Soc Sci Med. 1999 Jan;48(2):197-212. doi: 10.1016/s0277-9536(98)00331-1.
Ignorance about the costs, case loads and case mixes of different hospitals within the public health system constitutes an important obstacle to reforming health care spending in many developing countries. National (tertiary) hospitals generally receive significantly larger budgets, per patient, than lower-level (district) hospitals. One reason for these differential allocations is the widely held belief that national hospitals treat persons with more difficult illnesses and persons who are more severely ill than do other, non-national, hospitals. This belief is but a presumption and one that warrants investigation. This paper analyzes expenditures among public hospitals in El Salvador over a 12-year period to address this question. While controlling for patient morbidity, outputs and other characteristics, district hospitals are found to be substantially underfunded relative to national hospitals. Four policy options to redress this situation are examined.
对公共卫生系统内不同医院的成本、病例数量和病例组合缺乏了解，是许多发展中国家医疗保健支出改革的一个重要障碍。国家（三级）医院通常比基层（地区）医院获得的人均预算要多得多。这些差异分配的一个原因是人们普遍认为，国家医院比其他非国家医院治疗的疾病更难、病情更严重。这种看法只是一种假设，值得研究。本文分析了萨尔瓦多公立医院在12年期间的支出情况，以解决这个问题。在控制患者发病率、产出和其他特征的情况下，发现地区医院相对于国家医院的资金严重不足。本文研究了纠正这种情况的四种政策选择。
