Rosenstein A H
California Pacific Medical Center, San Francisco.
Hosp Health Serv Adm. 1991 Fall;36(3):313-30.
As health care spending continues to climb, government and industry, as the two major purchasers of health care services, are intensifying their scrutiny over health care delivery in an attempt to reduce their health care burden. The first round of utilization controls and reimbursement restrictions focused on necessity of admission and efficiency of care, causing a profound effect on hospital-based services. Declining occupancy rates, reduced inpatient reimbursements, and mounting contractual losses have pushed many hospitals to the point of financial disaster. The second round of controls has expanded into the outpatient sector and will begin to focus on both appropriateness of treatment and outcome of care, affecting both hospital and physician-related services. In an environment of increasing external pressures for appropriateness, justification and outcome of medical services, and potential financial risk imposed by reimbursement cutoffs or penalties for unnecessary care, hospitals and physicians are under increasing pressure to improve their efficiency as health care providers. The resource management model is presented as an example of how hospitals and physicians can monitor health care services and improve their performance in the delivery of more cost-efficient, high-quality medical care. The importance of hospital-physician education, communication, and interaction is stressed as a means of attaining internal control over a system plagued by resource-limited external constraints.
随着医疗保健支出持续攀升，作为医疗保健服务的两大主要购买方，政府和企业正在加强对医疗保健服务提供的审查，试图减轻其医疗保健负担。第一轮利用控制和报销限制聚焦于入院必要性和医疗效率，对医院服务产生了深远影响。入住率下降、住院报销减少以及合同损失不断增加，已将许多医院推向财务灾难的边缘。第二轮控制已扩展到门诊部门，并将开始关注治疗的适当性和医疗结果，影响医院和与医生相关的服务。在对医疗服务的适当性、合理性和结果的外部压力不断增加，以及报销削减或对不必要医疗的处罚所带来潜在财务风险的环境下，医院和医生作为医疗服务提供者，提高效率的压力越来越大。资源管理模式作为一个示例，展示了医院和医生如何监测医疗保健服务，并在提供更具成本效益、高质量医疗服务方面提高绩效。强调医院与医生之间教育、沟通和互动的重要性，将其作为对一个受资源有限的外部限制困扰的系统实现内部控制的一种手段。
