Miller M E, Welch W P
Urban Institute, Washington, DC 20037.
Health Care Financ Rev. 1993 Winter;15(2):155-71.
To control Medicare physician payments, Congress in 1989 established volume performance standards (VPS) that tie future physician fee increases to the growth in expenditures per beneficiary. The VPS risk pool is nationwide, and many observers believe it is too large to affect behavior. VPS could be modified by defining a separate risk pool for inpatient physician services and placing each hospital medical staff at risk for those services. Using a national random sample of 500,000 Medicare admissions, we explore the determinants of medical staff charges and comment on the policy implications. Multivariate analysis shows that charges increase with case mix and bed size but, surprisingly, decrease with the level of teaching activity. The teaching result is explained by the substitution of residents for physicians in these hospitals.
为控制医疗保险医师支付费用，国会于1989年制定了量效标准（VPS），该标准将未来医师费用的增加与每位受益人的支出增长挂钩。VPS风险池覆盖全国，许多观察家认为其规模太大，无法影响行为。可以通过为住院医师服务定义一个单独的风险池，并让每家医院的医务人员对这些服务承担风险，来修改VPS。我们使用全国50万例医疗保险住院病例的随机样本，探讨医务人员收费的决定因素，并对政策影响发表评论。多变量分析表明，收费随病例组合和床位规模的增加而增加，但令人惊讶的是，随着教学活动水平的提高而降低。教学活动导致的结果可以通过这些医院中住院医师替代医师的情况来解释。
