Sands G H, Muñoz E, Gottesman M, Mulloy K, Wise L
Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
Neurology. 1988 Apr;38(4):655-60. doi: 10.1212/wnl.38.4.655.
The DRG payment scheme is causing hospitals to examine the financial consequences of treating various patient populations. The purpose of this study was to examine resource utilization for hospitalized neurology patients treated during a 2-year period at an academic medical center. All patients (N = 1,993) were stratified by payor (Medicare, Medicaid, Blue Cross, and other) and age (0-35 years, 35-65 years, and 65 years and above). Mean hospital cost per patient (exclusive of MD fees) for each payor generally rose with age. Patients 35 years of age and over consumed a disproportionately larger share of resources than younger patients. DRG payment under an all payor system would have produced a substantial deficit for this group of patients. The mean hospital length of stay, number of diagnoses per patient, and mortality, as well as percent of admission through the emergency department generally rose with age. This study demonstrated that neurology patients 35 years of age and older generated higher resource utilization than their younger counterparts and were underpaid by the current DRG reimbursement. In this study, DRG payment appeared to provide significant financial disincentives to treat older neurology patients. If our findings are widespread, the quality of neurologic care and the elderly's access to it could become limited in the future.
疾病诊断相关分组（DRG）付费方案正促使医院审视治疗不同患者群体的财务后果。本研究的目的是调查在一所学术医疗中心接受治疗的住院神经科患者在两年期间的资源利用情况。所有患者（N = 1993）按付款方（医疗保险、医疗补助、蓝十字和其他）和年龄（0至35岁、35至65岁、65岁及以上）进行分层。每个付款方的每位患者平均住院费用（不包括医生费用）一般随年龄增长而上升。35岁及以上的患者比年轻患者消耗了不成比例的更多资源。在全付款方系统下的DRG付费会给这群患者带来巨额赤字。平均住院天数、每位患者的诊断数量、死亡率以及通过急诊科入院的百分比一般都随年龄增长而上升。本研究表明，35岁及以上的神经科患者比年轻患者产生了更高的资源利用，且在当前DRG报销制度下报酬不足。在本研究中，DRG付费似乎对治疗老年神经科患者提供了显著的财务抑制因素。如果我们的发现具有普遍性，未来神经科护理的质量以及老年人获得这种护理的机会可能会受到限制。
