Chesney J D
College of Urban, Labor, and Metropolitan Affairs, Wayne State University, Detroit, MI 48202.
Inquiry. 1990 Winter;27(4):376-81.
This article compares utilization trends for inpatient care before and after the introduction of Medicare's Prospective Payment System (PPS). Using discharges from a constant cohort of 419 hospitals over an eight-year period, I examine Medicare and non-Medicare utilization trends for the variables: total discharges, average length of stay (ALOS), average preoperative length of stay, average postoperative length of stay, percentage of patients using either ICU or CCU, and percentage of patients with consultations. Admission declines and the initial drop in ALOS are consistent with the initial program objectives and expectations. Post-PPS increases in ALOS, especially postoperative ALOS, are not consistent with PPS goals. Use of consultants and ICU/CCU facilities is not different before and after PPS.
本文比较了医疗保险预期支付系统（PPS）引入前后住院治疗的使用趋势。利用419家医院在八年期间固定队列的出院数据，我研究了医疗保险和非医疗保险在以下变量方面的使用趋势：总出院人数、平均住院时间（ALOS）、术前平均住院时间、术后平均住院时间、使用重症监护病房（ICU）或冠心病监护病房（CCU）的患者百分比以及会诊患者百分比。入院人数下降以及ALOS的最初下降与该计划的初始目标和预期一致。PPS实施后ALOS的增加，尤其是术后ALOS的增加，与PPS目标不一致。PPS实施前后顾问的使用以及ICU/CCU设施的使用没有差异。
