Douglass P S, Rosen R L, Butler P W, Bone R C
Chest. 1987 Mar;91(3):413-7. doi: 10.1378/chest.91.3.413.
Much concern has been expressed about the Medicare Prospective Payment System's impact on access to care. In this study, we examine the financial impact of diagnosis-related group (DRG) payment for chronic ventilator-dependent Medicare patients. During a one-year period, payment for 95 Medicare patients who received a minimum of three days of continuous ventilator treatment and who spent no time in surgical intensive care at Rush-Presbyterian-St. Luke's Medical Center, was calculated to be $2.2 million below costs, representing an average loss per discharge of $23,129. Patients stayed an average of 26.6 days, of which 14.2 days were spent on a ventilator. We conclude that the results suggest a financial bias against chronic ventilator-dependent patients exists in the DRG system which could present access problems. We recommend three approaches to recognizing the cost of care for such patients in the DRG payment system and encourage those in public policy-making positions to use our results as the basis for a larger scale analysis of the impact of Medicare DRG payment on chronic ventilator-dependent patients.
人们对医疗保险预付费制度对医疗服务可及性的影响表示了诸多担忧。在本研究中，我们考察了按诊断相关分组（DRG）付费对依赖呼吸机的慢性疾病医疗保险患者的财务影响。在为期一年的时间里，拉什长老会圣卢克医疗中心对95名接受了至少三天持续呼吸机治疗且未在外科重症监护室接受治疗的医疗保险患者的付费，经计算比成本低220万美元，这意味着每次出院平均损失23129美元。患者平均住院26.6天，其中14.2天使用呼吸机。我们得出结论，结果表明DRG系统中存在针对依赖呼吸机的慢性病患者的财务偏见，这可能会导致医疗服务可及性问题。我们建议采用三种方法来在DRG付费系统中识别此类患者的护理成本，并鼓励公共政策制定者将我们的研究结果作为对医疗保险DRG付费对依赖呼吸机的慢性病患者影响进行更大规模分析的基础。
