Schlenker R E
Center for Health Services Research, University of Colorado Health Sciences Center, Denver 80222.
Health Serv Res. 1991 Dec;26(5):623-49.
This analysis compares nursing home costs, Medicaid payment rates, and profits under three Medicaid nursing home payment systems: case-mix, facility-specific, and class-rate systems. Data used were collected from 135 nursing homes in seven states. The association of case mix with costs, rates, and profits under the three payment systems was of particular interest. Case mix was more strongly associated (positively) with patient care cost and the Medicaid rate for the case-mix systems than for the other systems, particularly the class-rate systems. In contrast, case mix and profits were not associated in the case-mix or facility-specific systems, but were negatively associated in the class rate systems. Overall, the results suggest that case-mix systems have some important advantages over other payment systems, but further research is needed on larger samples and involving the newer case-mix systems.
本分析比较了三种医疗补助养老院支付系统下的养老院成本、医疗补助支付率和利润：病例组合系统、特定机构系统和分类费率系统。所使用的数据是从七个州的135家养老院收集的。三种支付系统下病例组合与成本、费率和利润之间的关联尤其令人关注。与其他系统相比，病例组合系统中病例组合与患者护理成本及医疗补助费率的关联更为紧密（呈正相关），特别是与分类费率系统相比。相比之下，病例组合与利润在病例组合系统或特定机构系统中并无关联，但在分类费率系统中呈负相关。总体而言，结果表明病例组合系统相较于其他支付系统具有一些重要优势，但需要对更大样本并涉及更新的病例组合系统进行进一步研究。
