Goldfarb M G, Coffey R M
Inquiry. 1987 Spring;24(1):68-84.
It has been suggested that teaching hospitals as a group have done well financially under Medicare's prospective payment system. If so, is this because teaching hospitals have reduced inefficiencies or because their case mix is not as severe as presumed? In this study, we used Disease Staging and diagnosis related groups (DRGs) to isolate case mix attributed to given patient populations from that attributed to hospital treatment standards. We also analyzed differences among types of teaching hospitals. We found few case-mix differences between teaching and nonteaching hospitals when the weighting system was independent of resource consumption (i.e., Disease Staging). However, when resources were used to weight case-mix measurement (i.e., DRGs), teaching hospitals were found to have a more serious case mix. We conclude that although teaching hospitals typically do not have a more severe case mix than nonteaching hospitals, they do use more resources to treat their patient mix under DRGs.
有人认为，作为一个整体，教学医院在医疗保险的前瞻性支付系统下财务状况良好。如果是这样，这是因为教学医院降低了低效率，还是因为它们的病例组合不像假设的那么严重？在本研究中，我们使用疾病分期和诊断相关组（DRG）将特定患者群体的病例组合与医院治疗标准的病例组合区分开来。我们还分析了不同类型教学医院之间的差异。当权重系统与资源消耗无关（即疾病分期）时，我们发现教学医院和非教学医院之间几乎没有病例组合差异。然而，当使用资源对病例组合测量进行加权时（即DRG），发现教学医院的病例组合更严重。我们得出结论，虽然教学医院的病例组合通常不比非教学医院更严重，但在DRG下，它们确实使用更多资源来治疗其患者组合。
