Muñoz E, Mallett E, Gerold T, Goldstein J, Wise L
Division of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11042.
J Urol. 1988 Jun;139(6):1256-9. doi: 10.1016/s0022-5347(17)42883-7.
The Diagnostic Related Group payment mechanism is rapidly changing economic incentives for hospitals. We studied resource consumption and age for a large group of urology patients under Diagnostic Related Group reimbursement. Total hospital costs (exclusive of Diagnostic Related Group reimbursement. Total hospital costs (exclusive of physician fees) for the 1,281 urology patients studied were $8,895,264. Older urological patients consumed a disproportionately larger share of hospital resources. Mean hospital cost per patient, mean number of procedures, hospital length of stay and mortality generally increased with age. Under Diagnostic Related Group reimbursement, financial risk increased with age; patients 75 years and older generated significant financial risk to the hospital. Older patients often had a more intense resource use as measured by emergency or surgical intensive care unit admission, and blood and plasma protein requirements. These findings suggest that the current Diagnostic Related Group payment scheme may provide significant financial disincentives to hospitals vis-à-vis older urology patients and, thus, it could limit the access and quality of care for the older urology patient in the future.
诊断相关分组支付机制正在迅速改变医院的经济激励措施。我们研究了在诊断相关分组报销制度下一大群泌尿外科患者的资源消耗情况和年龄。在研究的1281名泌尿外科患者中，医院总成本（不包括诊断相关分组报销。医院总成本（不包括医生费用）为8,895,264美元。年龄较大的泌尿外科患者消耗的医院资源份额不成比例地更大。每位患者的平均医院成本、平均手术数量、住院时间和死亡率通常随着年龄的增长而增加。在诊断相关分组报销制度下，财务风险随着年龄的增长而增加；75岁及以上的患者给医院带来了重大的财务风险。通过急诊或外科重症监护病房入院以及血液和血浆蛋白需求来衡量，老年患者往往资源使用更为密集。这些发现表明，当前的诊断相关分组支付方案可能会给医院针对老年泌尿外科患者提供服务带来重大的经济抑制因素，因此，未来可能会限制老年泌尿外科患者获得医疗服务的机会和医疗服务质量。
