Qian Xufeng, Russell Louise B, Valiyeva Elmira, Miller Jane E
Moody's Investors Services, New York.
Bull Econ Res. 2011;63(1):1-27. doi: 10.1111/j.1467-8586.2010.00369.x.
Medicare's prospective payment system for hospitals (PPS), introduced in the USA in 1983, replaced cost reimbursement with a system of fixed rates which created incentives for hospitals to control costs. Previous studies found that elderly patients were discharged from hospital "quicker and sicker" under PPS and concluded that families were coping at home. We analyse a national longitudinal survey, the first National Health and Nutrition Examination Survey and its Epidemiologic Followup Study, which includes data on more outcomes over a longer period than earlier studies. We find that the rate of admission to nursing homes from the community in the first weeks after a hospital discharge more than tripled under PPS, suggesting that families were not always able to cope. As another response to sicker patients, discharges directly to nursing homes from hospitals, which jumped initially under PPS, may have risen further when payment rates were tightened in the early 1990s. Hospital readmissions fell after the first few years. Our findings are strengthened by the fact that we control for patients' health using health information collected independently of hospital admission.
1983年在美国推行的医疗保险机构针对医院的预期支付系统（PPS），用固定费率系统取代了费用报销制度，这促使医院控制成本。以往研究发现，在PPS系统下，老年患者出院时“更快但病情更重”，并得出家庭能够在家照顾的结论。我们分析了一项全国性纵向调查，即首次全国健康和营养检查调查及其流行病学随访研究，该研究包含的数据在结果方面比早期研究更多，时间跨度也更长。我们发现，在PPS系统下，出院后头几周内从社区入住疗养院的比例增加了两倍多，这表明家庭并非总能应对。作为对病情更重患者的另一种应对措施，医院直接将患者转至疗养院的情况在PPS系统推行初期有所增加，在20世纪90年代初支付费率收紧时可能进一步上升。最初几年后，医院再入院率有所下降。我们通过使用独立于医院入院情况收集的健康信息来控制患者健康状况，这一事实强化了我们的研究结果。
