Mehra Tarun, Koljonen Virve, Seifert Burkhardt, Volbracht Jörk, Giovanoli Pietro, Plock Jan, Moos Rudolf Maria
Medical Directorate, University Hospital Zurich, Switzerland.
Department of Plastic Surgery, Helsinki University and Helsinki University Hospital, Finland.
Swiss Med Wkly. 2015 Nov 24;145:w14217. doi: 10.4414/smw.2015.14217. eCollection 2015.
Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems.
A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established.
The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782-328 618 CHF vs 4 874-27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range -6 720 - 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of -33 178 CHF (30 856 EUR) (interquartile range -95 533 - 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2 of 0.67 (p <0.001 for LOS).
Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.
报销系统难以描述烧伤治疗的实际成本，给护理提供者带来了巨大的经济负担。我们的目标是建立一个与前瞻性支付系统兼容的简单而准确的报销模型。
回顾了2012年至2013年从瑞士大学医院出院的370966例患者的电子病历。共保留了828例烧伤病例，其中包括109例重度烧伤病例。分析了重度和非重度烧伤的成本、收入和收益，并建立了预测住院总治疗成本的线性回归模型。
重度烧伤每例的总成本中位数比非重度烧伤高10倍（179949瑞士法郎[167353欧元]对11312瑞士法郎[10520欧元]，四分位间距为96782 - 328618瑞士法郎对4874 - 27783瑞士法郎，p<0.001）。非重度烧伤每例的收益中位数为588瑞士法郎（547欧元）（四分位间距为 - 6720 - 5354瑞士法郎），而重度烧伤给护理提供者带来了巨大的经济损失，收益中位数为 - 33178瑞士法郎（30856欧元）（四分位间距为 - 95533 - 23662瑞士法郎）。差异非常显著（p<0.001）。我们以住院时间（LOS）为自变量预测每例总成本的线性回归模型调整后的R2为0.67（LOS的p<0.001）。
在瑞士报销系统中，重度烧伤的资金系统不足。基于固定费率诊断相关组的退款不能很好地反映实际治疗成本。总之，我们建议采用基于每日费率的报销模型来治疗重度烧伤。
