Muñoz E, Greenberg R, Faust G, Goldstein J D, Bank S, Wise L
Division of Gastroenterology, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
J Clin Gastroenterol. 1989 Aug;11(4):421-9. doi: 10.1097/00004836-198908000-00015.
Hospitals are now being reimbursed by a prospective Diagnosis-Related Group (DRG) classification system. There have been no major changes in the Federal Medicare DRG classification system since its inception 5 years ago. In this project, we analyzed all gastrointestinal (GI) medicine admissions by age and resource utilization at a large academic medical center. Total hospital costs for the 3,598 GI patients (January 1, 1985, through December 31, 1987) were $18,460,604. Although DRG reimbursement for all patients for the 3-year period would have generated an aggregate profit of $957,760, four out of five age categories of patients 65 years of age and above would have generated losses; the highest loss was for patients 85 years and over, at $2,235 per patient. Older GI patients (i.e., 65 years and over) had higher hospital costs, longer lengths of stay, more diagnoses and procedures per patient, and a higher mortality rate than younger patients. Both intensive care unit (ICU) and blood utilization rose with age. Thus, older GI patients consumed a disproportionately larger share of hospital resources. Our study suggests that the current DRG reimbursement scheme may be inequitable relative to the older GI medicine patient; financial disincentives from DRGs may affect elderly patients' access to and quality of care in the future.
医院目前正通过一种前瞻性的诊断相关分组（DRG）分类系统获得报销。自5年前联邦医疗保险DRG分类系统设立以来，没有发生重大变化。在本项目中，我们分析了一家大型学术医疗中心按年龄和资源利用情况划分的所有胃肠（GI）科住院病例。3598名胃肠科患者（1985年1月1日至1987年12月31日）的医院总费用为18460604美元。尽管这三年期间所有患者的DRG报销本可产生总计957760美元的利润，但65岁及以上的五个年龄组中有四个组会出现亏损；85岁及以上患者的亏损最高，每位患者亏损2235美元。老年胃肠科患者（即65岁及以上）比年轻患者的住院费用更高、住院时间更长、每位患者的诊断和治疗程序更多，死亡率也更高。重症监护病房（ICU）的使用和血液使用量均随年龄增长而增加。因此，老年胃肠科患者消耗了不成比例的更多医院资源。我们的研究表明，相对于老年胃肠科患者而言，当前的DRG报销方案可能不公平；DRG带来的经济抑制因素可能会影响老年患者未来获得医疗服务的机会和医疗质量。
