Magnezi R, Dankner R, Kedem R, Reuveni H
Medical Service and Supply Center, Medical Corps, Israel Defense Forces, Israel.
J R Army Med Corps. 2007 Mar;153(1):22-5. doi: 10.1136/jramc-153-01-07.
This study analyzes the effect of outsourcing healthcare on career soldiers in the Israel Defense Forces (IDF) in different settings, so as to develop a model for predicting per capita medical costs
Demographic information and data on healthcare utilization and costs were gathered from three computerized billing database systems: The IDF Medical Corps; a civilian hospital; and a healthcare fund, providing services to 3,746; 3,971; and 6,400 career soldiers, respectively. Visits to primary care physicians and specialists, laboratory and imaging exams, number of sick-leave days, and hospitalization days, were totaled for men and women separately for each type of clinic. A uniform cost was assigned to each type of treatment to create an average annual per capita cost for medical services of career soldiers.
Significantly more visits were recorded to primary care physician and to specialists, as well as imaging examinations by Leumit Healthcare Services (LHS), than visits and tests in hospitals or in military clinics (p < 0.001). The number of referrals to emergency rooms and sick-leave days were lowest in the LHS as compared to the hospital and military clinics (p < 0.001). The medical cost per capita/year was lowest in LHS as well.
Outsourcing primary care for career soldiers to a civilian healthcare fund represents a major cost effective change, lowest consumption and lower cost of medical care. Co-payment should be integrated into every agreement with the medical corps.
本研究分析了在不同环境下，医疗服务外包对以色列国防军职业军人的影响，以便建立一个人均医疗费用预测模型。
从三个计算机计费数据库系统收集人口统计学信息以及医疗服务利用和费用数据：以色列国防军医疗队；一家 civilian 医院；以及一个医疗基金，分别为3746名、3971名和6400名职业军人提供服务。按诊所类型分别统计男性和女性看初级保健医生和专科医生的次数、实验室和影像检查、病假天数以及住院天数。为每种治疗类型分配统一成本，以计算职业军人医疗服务的人均年成本。
与在医院或军事诊所的就诊和检查相比，Leumit 医疗服务公司（LHS）记录的看初级保健医生和专科医生的次数以及影像检查次数明显更多（p < 0.001）。与医院和军事诊所相比，LHS 的急诊转诊次数和病假天数最低（p < 0.001）。LHS 的人均医疗费用/年也是最低的。
将职业军人的初级保健外包给 civilian 医疗基金是一项具有重大成本效益的变革，医疗消费最低且成本更低。每次与医疗队的协议都应纳入共同支付条款。
