Pietz Kenneth, Byrne Margaret M, Daw Christina, Petersen Laura A
Division of Health Policy and Quality, Houston Center for Quality of Care and Utilization Studies, Veterans Health Affairs, Houston, Texas, USA.
Med Care. 2007 Oct;45(10):951-8. doi: 10.1097/MLR.0b013e31812f4f48.
(1) To investigate whether inpatients referred or transferred between facilities result in increased financial loss compared with those admitted directly, in a health care delivery system funded by capitation methods. (2) To determine whether the higher cost of those patients transferred or referred is fairly compensated by a diagnosis-based risk adjustment system, and whether tertiary care facilities bear an unfair financial burden for such patients in a capitated financing environment.
The study cohort included all Veterans Affairs (VA) beneficiaries who received inpatient care during fiscal year (FY) 2004. Referral was defined as an outpatient visit to 1 facility followed by an admission to another facility. Transfers were consecutive inpatient stays at different hospitals. We defined loss as cost minus the share of budget determined by a Diagnostic Cost Group-based allocation. Both t tests and linear regression were used to compare the effect on cost and loss for patients transferred or not and referred or not.
Mean loss to a facility for patients transferred in was 1231 dollars more than for those not transferred. Mean loss for referred patients was 3341 dollars more than for those not referred, controlling for disease burden. For tertiary hospitals, the difference in losses for transfer patients was less than for other hospitals but greater for referral patients.
Patients referred or transferred from other facilities are more costly than those who are not. The difference may not be compensated by a diagnosis-based allocation system. A capitated health care system may consider additional funding to cover the cost of such patients.
（1）在按人头付费的医疗保健提供系统中，调查与直接入院的患者相比，在不同机构间转诊或转院的住院患者是否会导致更高的财务损失。（2）确定基于诊断的风险调整系统是否能公平地补偿那些转诊或转院患者的较高成本，以及在按人头付费的融资环境下，三级医疗机构是否为此类患者承担了不公平的财务负担。
研究队列包括2004财年接受住院治疗的所有退伍军人事务部（VA）受益人。转诊定义为在一个机构进行门诊就诊后再入住另一个机构。转院是指在不同医院的连续住院。我们将损失定义为成本减去基于诊断成本组分配确定的预算份额。t检验和线性回归均用于比较转诊或未转诊、转院或未转院患者对成本和损失的影响。
转院患者给机构带来的平均损失比未转院患者多1231美元。在控制疾病负担的情况下，转诊患者的平均损失比未转诊患者多3341美元。对于三级医院，转院患者的损失差异小于其他医院，但转诊患者的损失差异更大。
从其他机构转诊或转院的患者比未转诊或转院的患者成本更高。这种差异可能无法通过基于诊断的分配系统得到补偿。按人头付费的医疗保健系统可能需要考虑额外的资金来支付此类患者的费用。
