Smith D B, Pickard R
Health Serv Res. 1986 Oct;21(4):529-46.
The article evaluates the impact of Medicare and Medicaid DRG prospective payment on utilization in Philadelphia area hospitals. These hospitals began a combined Medicare-Medicaid DRG prospective payment at the same time after a common cost-based reimbursement history. Particular attention is paid to the hospital-driven as opposed to physician-driven explanations of declining inpatient utilization. The evaluation of the Tax Equity and Fiscal Responsibility Act (TEFRA) and Diagnosis-Related Group (DRG) interventions uses an ARIMA model that removes both seasonal and autoregressive effects. Both TEFRA and the DRG payment system produced significant reductions in average length of stay, total hospital days, and hospital occupancy rates. Neither, however, had a significant effect on admissions. Hospitals with a higher proportion of Medicare and Medicaid discharges reduced their average length of stay more than other facilities. Hospitals with a higher proportion of outpatient visits to inpatient admissions also reduced inpatient length of stay more. Hospitals with higher than expected overall admissions after the introduction of the DRG program tended to have lower than expected average lengths of stay. The results lend support to the "hospital-driven" interpretation of declines in average length of stay. They fail to support the contention that the DRG system will produce automatic counteracting increases in admissions in the system as a whole.
本文评估了医疗保险和医疗补助诊断相关分组（DRG）预期支付对费城地区医院医疗服务利用情况的影响。在经历了基于成本的统一报销历史后，这些医院同时开始实施医疗保险和医疗补助DRG预期支付制度。特别关注的是，与医生驱动的解释相对，由医院驱动的住院服务利用下降的解释。对《税收公平与财政责任法》（TEFRA）和诊断相关分组（DRG）干预措施的评估使用了一种自回归整合移动平均（ARIMA）模型，该模型消除了季节性和自回归效应。TEFRA和DRG支付系统均使平均住院天数、总住院日数和医院占用率显著降低。然而，两者对入院人数均无显著影响。医疗保险和医疗补助出院比例较高的医院，其平均住院天数的减少幅度大于其他机构。门诊就诊与住院入院比例较高的医院，其住院天数的减少幅度也更大。在引入DRG计划后，总体入院人数高于预期的医院，其平均住院天数往往低于预期。这些结果支持了对平均住院天数下降的“医院驱动”解释。它们未能支持DRG系统将在整个系统中自动产生抵消性入院人数增加这一论点。
