Health Policy and Informatics Section, Department of Health Policy, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Tokyo 1138519, Japan.
Health Policy. 2012 Nov;108(1):86-92. doi: 10.1016/j.healthpol.2012.08.021. Epub 2012 Sep 16.
Teaching hospitals require excess medical resources to maintain high-quality care and medical education. To evaluate the appropriateness of such surplus costs, we examined the impact of teaching intensity defined as activities for postgraduate training, and academic status as functions of medical research and undergraduate teaching on medical resource utilization. Administrative data for 47,397 discharges from 40 academic and 12 non-academic teaching hospitals in Japan were collected. Hospitals were classified into three groups according to intern/resident-to-bed (IRB) ratio. Resource utilization of medical services was estimated using fee-for-service charge schedules and normalized with case mix grouping. 15-24% more resource utilization for laboratory examinations, radiological imaging, and medications were observed in hospitals with higher IRB ratios. With multivariate adjustment for case mix and academic status, higher IRB ratios were associated with 10-15% more use of radiological imaging, injections, and medications; up to 5% shorter hospital stays; and not with total resource utilization. Conversely, academic status was associated with 21-33% more laboratory examinations, radiological imaging, and medications; 13% longer hospital stays; and 10% more total resource utilization. While differences in medical resource utilization by teaching intensity may not be associated with indirect educational costs, those by academic status may be. Therefore, academic hospitals may need efficiency improvement and financial compensation.
教学医院需要额外的医疗资源来维持高质量的医疗和医学教育。为了评估这种过剩成本的合理性，我们研究了教学强度（定义为研究生培训活动）和学术地位（作为医学研究和本科教学的功能）对医疗资源利用的影响。我们收集了日本 40 家学术医院和 12 家非学术教学医院的 47397 名出院患者的行政数据。根据实习医生/住院医生与床位的比例（IRB），将医院分为三组。医疗服务的资源利用使用按服务收费表进行估计，并按病例组合分组进行标准化。IRB 比例较高的医院，实验室检查、放射影像学和药物的资源利用增加了 15%-24%。在调整病例组合和学术地位的多变量后，较高的 IRB 比例与放射影像学、注射和药物的使用增加 10%-15%、住院时间缩短 5%以下、总资源利用没有关系。相反，学术地位与实验室检查、放射影像学和药物的使用增加 21%-33%、住院时间延长 13%、总资源利用增加 10%有关。虽然教学强度引起的医疗资源利用差异可能与间接教育成本无关，但学术地位引起的差异可能与教育成本有关。因此，学术医院可能需要提高效率和获得经济补偿。
