Arndt M, Bradbury R C
Clark University, Graduate School of Management, Worcester, MA 01610, USA.
Hosp Health Serv Adm. 1995 Summer;40(2):210-26.
This study compares Medicaid patients and privately insured patients. Regression analyses examine the effect of Medicaid status on hospital admission severity, length of stay, and ancillary charges for 14,557 patients in ten medical DRGs and ten surgical procedures. The results show that Medicaid patients were significantly sicker on admission, especially the medical patients. After adjustments for patient age and sex, admission severity of illness, case mix, and hospital, Medicaid patients still had significantly longer lengths of stay and higher ancillary charges, although the effect was not as strong for ancillary charges. We suggest that this association between Medicaid status and length of stay and ancillary charges may be due to greater difficulty in discharge planning for Medicaid patients, health status differences not captured adequately in severity classification, and utilization review practices. The implications of these findings for hospital management, health care policy, and future research are discussed.
本研究对医疗补助患者和私人保险患者进行了比较。回归分析考察了医疗补助状态对10个内科疾病诊断相关分组（DRG）和10种外科手术中14557例患者的入院严重程度、住院时间和辅助费用的影响。结果显示，医疗补助患者入院时病情明显更重，尤其是内科患者。在对患者年龄、性别、入院疾病严重程度、病例组合和医院进行调整后，医疗补助患者的住院时间仍显著更长，辅助费用也更高，尽管辅助费用方面的影响没有那么大。我们认为，医疗补助状态与住院时间和辅助费用之间的这种关联可能是由于医疗补助患者出院计划难度更大、严重程度分类中未充分体现的健康状况差异以及利用审查实践。本文讨论了这些发现对医院管理、医疗保健政策和未来研究的意义。
