Boyce J M, Potter-Bynoe G, Dziobek L, Solomon S L
Department of Medicine, Miriam Hospital, Providence, RI 02906.
Arch Intern Med. 1991 Jun;151(6):1109-14. doi: 10.1001/archinte.151.6.1109.
To determine the extent to which hospitals are reimbursed for Medicare patients who develop nosocomial pneumonia, we analyzed hospital accounting costs, reimbursements received, and the net income from 33 Medicare patients who developed nosocomial pneumonia. In 31 of the 33 cases, hospital costs for the entire admission exceeded reimbursements, with a median net loss of $5800 per case. Eleven randomly selected pneumonia cases were compared with control patients matched by diagnosis related group, age, sex, and service. Cases had significantly longer hospital stays, had greater total hospital costs, and caused greater net losses than did matched controls. We conclude that hospitals are seldom reimbursed adequately for Medicare patients who develop nosocomial pneumonia. With the advent of the prospective payment system, hospitals now have substantial financial incentives for implementing cost-effective measures for preventing nosocomial pneumonias.
为了确定医院对发生医院获得性肺炎的医疗保险患者的报销程度，我们分析了33例发生医院获得性肺炎的医疗保险患者的医院会计成本、收到的报销款以及净收入。在这33例中的31例中，整个住院期间的医院成本超过了报销款，每例的中位净亏损为5800美元。将11例随机选择的肺炎病例与按诊断相关组、年龄、性别和服务匹配的对照患者进行比较。与匹配的对照组相比，病例的住院时间明显更长，医院总成本更高，净亏损更大。我们得出结论，对于发生医院获得性肺炎的医疗保险患者，医院很少能得到足够的报销。随着前瞻性支付系统的出现，医院现在有很大的经济激励来实施具有成本效益的措施以预防医院获得性肺炎。
