Evans R L, Hendricks R D, Bishop D S, Lawrence-Umlauf K V, Kirk C, Halar E M
School of Social Work, University of Washington, Seattle.
Arch Phys Med Rehabil. 1990 Apr;71(5):291-4.
Suspected benefits of a prospective payment system (PPS) in which hospitals are paid by diagnosis-related groups (DRGs) are that hospital lengths of stay and costs may be reduced. The US Department of Veterans Affairs is one of the first agencies to adopt PPS funding for rehabilitation; this early adoption of PPS provides a unique opportunity to test for both beneficial and adverse outcomes. This study compared hospital stay, readmission rate, and incidence of nursing home placement before and after introduction of PPS on a 22-bed rehabilitation service. Hospital stay decreased from 29.3 days to 26.4 days, but 64% more patients were discharged to nursing homes. Findings suggest that PPS may overlook home care in favor of placement, which neutralizes the cost benefits of the proposed reimbursement system. Further research on the effects of PPS is needed to determine (1) impact on clinical aspects of rehabilitation and (2) whether other funding mechanisms are more appropriate.
预期支付系统（PPS）按诊断相关分组（DRG）向医院支付费用，其潜在益处在于可能缩短住院时间并降低成本。美国退伍军人事务部是最早采用PPS为康复服务提供资金的机构之一；这种对PPS的早期采用为测试其有益和不良结果提供了独特机会。本研究比较了在一个拥有22张床位的康复服务机构引入PPS前后的住院时间、再入院率和养老院安置发生率。住院时间从29.3天降至26.4天，但出院后被安置到养老院的患者增加了64%。研究结果表明，PPS可能忽视家庭护理而倾向于安置，这抵消了拟议报销系统的成本效益。需要对PPS的影响进行进一步研究，以确定（1）对康复临床方面的影响，以及（2）其他资金机制是否更合适。
