Weissert W G, Musliner M C
Department of Health Services Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109-2029.
Milbank Q. 1992;70(3):455-90.
Nursing-home case mix adjusted payment systems typically base payments on estimates of patients' care needs, but to date the data on their effectiveness are ambiguous. Studies mainly show that access for patients most in need of care appears to improve under these systems. Case mix based payment systems have both positive and negative effects on quality of care and require compensating mechanisms for the potentially harmful incentives they can generate. On the positive side, nursing homes are paid more equitably; the negative aspect is reflected in higher costs, particularly for administration. A Health Care Financing Administration (HCFA) demonstration project may provide insights, but its limited number of predominantly small, rural, participating states, its tandem quality assurance system, and potentially confounding market variables may restrict the value of this project. We do not yet have the data to assess the impact of instituting case mix adjustment systems.
疗养院病例组合调整支付系统通常根据对患者护理需求的估计来确定支付金额，但迄今为止，关于其有效性的数据尚不明确。研究主要表明，在这些系统下，最需要护理的患者的就医机会似乎有所改善。基于病例组合的支付系统对护理质量既有积极影响，也有消极影响，并且需要针对它们可能产生的潜在有害激励措施建立补偿机制。从积极方面来看，疗养院获得了更公平的支付；消极方面则体现在成本增加，尤其是行政管理成本。医疗保健财务管理局（HCFA）的一个示范项目可能会提供一些见解，但其参与的主要是小型农村州数量有限，其配套的质量保证体系以及潜在的混淆市场变量可能会限制该项目的价值。我们尚无数据来评估实施病例组合调整系统的影响。
