Leonard Kevin J, Rauner Marion S, Schaffhauser-Linzatti Michaela Maria, Yap Richard
Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 12 Queens Park Crescent West, Toronto, Ont., Canada M5S 1A8.
Health Policy. 2003 Mar;63(3):239-57. doi: 10.1016/s0168-8510(02)00082-9.
This paper compares two different funding policies for inpatients, the case-based approach in Austria versus the global budgeting approach in Canada. It examines the impact of these funding policies on length of stay of inpatients as one key measure of health outcome. In our study, six major clinical categories for inpatients are selected in which the day of the week for admission is matched to the particular day of the week of discharge for each individual case. The strategic statistical analysis proves that funding policies have a significant impact on the expected length of stay of inpatients. For all six clinical categories, Austrian inpatients stayed longer in hospitals compared to Canadian inpatients. Moreover, inpatients were not admitted and discharged equally throughout the week. We also statistically prove for certain clinical categories that more inpatients are discharged on certain days such as Mondays or Fridays depending on the funding policy. Our study is unique in the literature and our conclusions indicate that, with the right incentives in place, the length of stay can be decreased and discharge anomalies can be eliminated, which ultimately leads to a decrease in healthcare expenditures and an increase in healthcare effectiveness.
本文比较了两种针对住院患者的不同资金政策，即奥地利的按病例付费法与加拿大的总额预算制。它考察了这些资金政策对住院患者住院时长的影响，将其作为衡量健康结果的一项关键指标。在我们的研究中，选取了住院患者的六个主要临床类别，其中每个病例的入院星期与出院星期相匹配。策略性统计分析证明，资金政策对住院患者的预期住院时长有显著影响。在所有六个临床类别中，奥地利住院患者的住院时间比加拿大住院患者更长。此外，住院患者在一周内的入院和出院情况并不均衡。我们还通过统计证明，对于某些临床类别，根据资金政策，在特定日期（如周一或周五）出院的住院患者更多。我们的研究在文献中独具特色，我们的结论表明，通过适当的激励措施，可以缩短住院时长并消除出院异常情况，这最终会导致医疗保健支出的减少和医疗保健效果的提高。
