Thorpe K E
Department of Health Policy and Management, School of Public Health, Harvard University, Boston, MA 02115.
Inquiry. 1988 Summer;25(2):219-31.
Although the intention of Medicare policy makers was to use only "legitimate" cost differences to adjust teaching hospital payment rates under the prospective payment system (PPS), the actual calculations implicitly recognized others. In this paper I question whether these implicit costs should be passed through, and whether regression analysis was used correctly to establish reimbursement rates for hospitals under PPS. Conducting regression analyses on a more inclusive set of variables than the Health Care Financing Administration (HCFA) used to establish its adjustments, I conclude that costs in teaching hospitals rise only 3.15% for each .1 increment in the resident-to-bed ratio, far lower than HCFA's original 11.59% adjustment and substantially lower than the current adjustment of 7.7% for indirect costs.
尽管医疗保险政策制定者的意图是仅使用“合理的”成本差异来调整预期支付系统（PPS）下教学医院的支付率，但实际计算中隐含地承认了其他成本差异。在本文中，我质疑这些隐含成本是否应被转嫁，以及回归分析在确定PPS下医院报销率时是否被正确使用。通过对一组比医疗保健财务管理局（HCFA）用于确定其调整的变量更具包容性的变量进行回归分析，我得出结论，住院医师与床位比每增加0.1，教学医院的成本仅上升3.15%，远低于HCFA最初的11.59%的调整幅度，也大大低于目前7.7%的间接成本调整幅度。
