Nayar Preethy
Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center, PO Box 984350, The Nebraska Medical Center, Omaha, USA.
Health Care Manage Rev. 2008 Jul-Sep;33(3):264-73. doi: 10.1097/01.HMR.0000324911.26896.d8.
Long-term acute care hospitals (LTACHs) treat patients with complex medical conditions requiring hospital care for extended periods of time. In the last decade, Medicare saw spiraling costs for post-acute care settings. The Balanced Budget Act mandated the use of Prospective Payment System (PPS) for all post-acute care settings including LTACHs. Medicare shifted to PPS for LTACHs in October 2002.
This study analyzes the early effect of Medicare's PPS on the staffing intensity of LTACHs.
METHODOLOGY/APPROACH: The study uses panel data of measures of hospital and market characteristics in years 2001 through 2004. The impact of the payment mechanism, market, and organizational variables on the staffing intensity of LTACHs is evaluated using fixed-effects (within-groups) regression analysis.
The fixed-effects regression models found that Medicare's PPS was associated with higher staffing intensity of the LTACHs in years 2003 and 2004. Market-level per capita income was significantly positively associated with staffing intensity. No secular trend in staffing intensity was found.
The concern that the cost containment incentives of PPS would result in lowered staffing levels of LTACHs was not borne out by this study. Further follow-up is required to assess in the longer term the effects of PPS on staffing and quality of care in LTACHs.
长期急性病医院（LTACHs）治疗患有复杂医疗状况的患者，这些患者需要长时间住院治疗。在过去十年中，医疗保险（Medicare）发现急性后期护理机构的成本不断攀升。《平衡预算法案》规定对包括LTACHs在内的所有急性后期护理机构使用前瞻性支付系统（PPS）。医疗保险于2002年10月转向对LTACHs使用PPS。
本研究分析医疗保险的PPS对LTACHs人员配备强度的早期影响。
方法/途径：该研究使用了2001年至2004年医院和市场特征指标的面板数据。使用固定效应（组内）回归分析评估支付机制、市场和组织变量对LTACHs人员配备强度的影响。
固定效应回归模型发现，医疗保险的PPS在2003年和2004年与LTACHs较高的人员配备强度相关。市场层面的人均收入与人员配备强度显著正相关。未发现人员配备强度的长期趋势。
本研究并未证实对PPS成本控制激励措施会导致LTACHs人员配备水平降低的担忧。需要进一步随访以长期评估PPS对LTACHs人员配备和护理质量的影响。
