Bojke Chris, Grašič Katja, Street Andrew
Centre for Health Economics, University of York, York, United Kingdom.
Health Econ. 2018 Jan;27(1):e26-e38. doi: 10.1002/hec.3525. Epub 2017 May 19.
The English National Health Service is promoting concentration of the treatment of patients with relatively rare and complex conditions into a limited number of specialist centres. If these patients are more costly to treat, the prospective payment system based on Healthcare Resource Groups (HRGs) may need refinement because these centres will be financially disadvantaged. To assess the funding implications of this concentration policy, we estimate the cost differentials associated with caring for patients that receive complex care and examine the extent to which complex care services are concentrated across hospitals and HRGs. We estimate random effects models using patient-level activity and cost data for all patients admitted to English hospitals during the 2013/14 financial year and construct measures of the concentration of complex services. Payments for complex care services need to be adjusted if they have large cost differentials and if provision is concentrated within a few hospitals. Payments can be adjusted either by refining HRGs or making top-up payments to HRG prices. HRG refinement is preferred to top-payments the greater the concentration of services among HRGs.
英国国家医疗服务体系正在推动将相对罕见和复杂病症患者的治疗集中到数量有限的专科中心。如果治疗这些患者的成本更高，那么基于医疗资源组（HRGs）的前瞻性支付系统可能需要改进，因为这些中心在财务上会处于不利地位。为了评估这一集中政策对资金的影响，我们估计了与护理接受复杂护理的患者相关的成本差异，并研究了复杂护理服务在各医院和医疗资源组之间的集中程度。我们使用2013/14财年入住英国医院的所有患者的患者层面活动和成本数据估计随机效应模型，并构建复杂服务集中程度的度量指标。如果复杂护理服务存在较大的成本差异，且服务集中在少数几家医院，那么就需要调整对这些服务的支付。支付可以通过细化医疗资源组或对医疗资源组价格进行追加支付来调整。在医疗资源组中服务集中程度越高，越倾向于细化医疗资源组而非追加支付。
