Brooks J H, Renz K K, White S E, Richardson S L
Foundation for Social and Scientific Inquiry, Columbus, OH 43230.
Am J Med Qual. 1992 Winter;7(4):116-9. doi: 10.1177/0885713x9200700405.
Peer review organizations (PRO) review the health care given to Medicare beneficiaries. If a PRO determines that a hospital admission was unnecessary, the hospital is not reimbursed for the medical care and the case is "denied." The average hospital denial rate on Ohio is 2%; however, the denial rate for hospital admissions of one day or less is 7.5%. An analysis of hospitals and diagnoses for one-day hospital admission denials was performed, showing that urban hospitals and disorders of the circulatory and digestive systems predominate. The inappropriate utilization of health care resources costs millions of dollars per year in Ohio and could be costing the nation billions of dollars. There is an urgent need to research why resources are used less effectively by some hospitals and for some diseases.
同行评审组织（PRO）会对给予医疗保险受益人的医疗服务进行评审。如果PRO认定某例住院是不必要的，医院将无法获得该医疗服务的报销，此病例即被“拒付”。俄亥俄州医院的平均拒付率为2%；然而，住院一天及以内的拒付率为7.5%。对一日住院拒付病例的医院及诊断情况进行了分析，结果显示城市医院以及循环系统和消化系统疾病占主导。在俄亥俄州，每年医疗资源的不当利用造成了数百万美元的损失，而在全国范围内可能造成数十亿美元的损失。迫切需要研究为何一些医院在某些疾病的治疗上对资源的利用效率较低。
