Fisher E S, Welch H G, Wennberg J E
Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH 03755-3862.
JAMA. 1992 Apr 8;267(14):1925-31. doi: 10.1001/jama.267.14.1925.
To provide an alternative to Oregon's treatment-specific approach to rationing, we propose a prioritization based on the local hospital resources invested in discretionary medical admissions.
We used 1988 Oregon hospital discharge data to determine age- and sex-adjusted per-capita rates of inpatient days for discretionary medical admissions (for high-variation medical conditions) in each of 33 hospital service areas. Potential ceiling rates were defined based on prevailing utilization rates for discretionary medical admissions in each hospital service area. Savings were calculated under the assumption that resources allocated for inpatient treatment of these conditions in areas that exceed the ceiling rates were reduced accordingly.
Nonfederal, acute-care hospitals used by Oregon residents.
Oregon residents.
Savings were defined in terms of patient days, hospital beds, hospital charges, and average costs.
Among the 16 largest hospital service areas, patient-day rates for discretionary medical admissions ranged from 188 to 335 patient days per thousand. Potential savings from applying different ceiling rates ranged from $0.4 million to $94.7 million per year. If the rate in the state capital (Salem) were used as the ceiling (218 days per thousand), then 238 beds could be closed in 20 hospital service areas, for an estimated cost savings of $47.3 million.
Hospital resources invested in discretionary admissions in high-rate areas represent an important potential source of funds for reallocation to meet other defined health care needs. Setting limits based on units of health care supply (eg, beds, capital equipment, and physicians) should be considered as an option for resource reallocation within health care.
为替代俄勒冈州按治疗项目配给的方法，我们提议根据当地医院在选择性医疗入院方面投入的资源进行优先排序。
我们使用1988年俄勒冈州医院出院数据来确定33个医院服务区中每个区针对选择性医疗入院（针对高变异医疗状况）的年龄和性别调整后的人均住院天数率。根据每个医院服务区选择性医疗入院的普遍利用率确定潜在上限率。假设超过上限率地区用于这些疾病住院治疗的资源相应减少，计算节约情况。
俄勒冈州居民使用的非联邦急症护理医院。
俄勒冈州居民。
节约情况根据患者住院天数、医院病床数、医院收费和平均成本来定义。
在16个最大的医院服务区中，选择性医疗入院的患者住院天数率为每千人188至335天。应用不同上限率的潜在节约金额每年从40万美元到9470万美元不等。如果将州府（塞勒姆）的比率用作上限（每千人218天），那么20个医院服务区可关闭238张病床，估计节约成本4730万美元。
高比率地区在选择性入院方面投入的医院资源是重新分配以满足其他明确医疗保健需求的重要潜在资金来源。应考虑将基于医疗保健供应单位（如病床、资本设备和医生）设定限制作为医疗保健内部资源重新分配的一种选择。
