Sances G, Sandrini G, Costa A, Antonaci F, Citterio A, Nappi G
University Centre for Adaptive Disorders and Headache, University of Pavia, IRCCS C. Mondino Institute of Neurology, Via Palestro 3, 27100 Pavia, Italy.
Funct Neurol. 2000;15 Suppl 3:224-9.
Headache is an extremely common disorder which has a marked impact on the utilisation of healthcare resources and constitutes a considerable socio-economic burden. The related costs, both direct and indirect, are especially high in developed countries, since headache predominantly affects an economically-active section of the population. The Diagnosis-Related Groups (DRG) system, a method for reimbursing healthcare structures for patient admissions, was introduced in Italy in 1995. The aim of the system was to control public health expenditure and to promote better distribution of financial resources. Here, we report the results of the application of the DRG system to headache patients admitted to the Department of Neurology of the University of Pavia in 1996 and 1998. The financial analysis revealed high fixed costs (hospital running costs per days of hospitalisation); by contrast, the impact of the variable costs (those relating to the direct management of the individual patient, i.e. examinations, therapeutic interventions etc.) was low. It was found that reducing the number of days of hospitalisation increases the hospital's income and reduces the mean loss incurred in each DRG. It is therefore suggested that a complete approach to the management of headache must include educational programmes for patients and general practitioners, and that access to headache centres and to hospital care should be restricted to cases of acute, severe headache, or recurrent, chronic headache with/without drug abuse or dependence.
头痛是一种极为常见的病症，对医疗资源的利用有着显著影响，并构成相当大的社会经济负担。在发达国家，相关的直接和间接成本尤其高昂，因为头痛主要影响的是具有经济活动能力的人群。诊断相关分组（DRG）系统是一种针对患者住院情况向医疗机构进行报销的方法，于1995年在意大利推行。该系统的目的是控制公共卫生支出并促进财政资源的更合理分配。在此，我们报告了1996年和1998年将DRG系统应用于帕维亚大学神经科收治的头痛患者的结果。财务分析显示固定成本较高（住院每日的医院运营成本）；相比之下，可变成本（与个体患者的直接管理相关的成本，即检查、治疗干预等）的影响较低。研究发现，减少住院天数可增加医院收入并减少每个DRG产生的平均损失。因此，建议对头痛的全面管理方法必须包括针对患者和全科医生的教育项目，并且只有急性、重度头痛病例，或伴有/不伴有药物滥用或依赖的复发性慢性头痛病例，才有资格进入头痛中心并接受住院治疗。
