Munoz E, Greenberg R, Chalfin D, Bank S, Mulloy K, Wise L
Division of Gastroenterology, Long Island Jewish Medical Center, New Hyde Park, New York.
Am J Gastroenterol. 1988 Sep;83(9):957-62.
The federal Medicare diagnosis-related group (DRG) hospital payment system has been on-line for 5 yr with no major adverse effects on either access or quality of care. The hospital industry contends that DRGs are underpaying for hospital care, especially for certain types of patients. Analysis of 2,500 gastroenterology patients by outcome (i.e., survivors vs mortalities) demonstrated that the 122 mortalities had a much greater intensity of hospital resource utilization, and generated substantial financial risk under DRG pricing schemes, compared with the 2,378 survivors. Only mortalities that occurred within 1 wk of admission to the hospital were profitable under DRGs. A long hospital length of stay (LOS) for mortalities was very unprofitable (mortalities with more than a 60-day LOS generated $20,210 loss per patient). Emergency gastroenterology admissions who died had greater financial risk under DRGs, compared to nonemergency mortalities. Those mortalities referred to gastroenterology from other clinical services tended to have greater resource utilization and financial risk under DRGs, compared with nonreferred mortalities. These data suggest significant inequities in the current DRG prospective payment system vis-a-vis gastrotenterology mortalities. Predictive variables of greater hospital resource utilization for gastroenterology mortalities include longer hospital lengths of stay, emergency admission, and referral from another clinical service. If equity of DRG payment is not improved by the federal government, certain groups of patients likely to be mortalities may suffer a decline in access and/or the quality of medical care in the future.
联邦医疗保险诊断相关分组（DRG）医院支付系统已上线5年，对医疗服务的可及性或质量均未产生重大不利影响。医院行业认为，DRG对医院医疗服务的支付不足，尤其是对某些类型的患者。通过对2500例胃肠病患者按转归情况（即存活者与死亡者）进行分析表明，与2378例存活者相比，122例死亡者的医院资源利用强度要大得多，并且在DRG定价方案下产生了巨大的财务风险。只有在入院1周内发生的死亡病例在DRG下才是盈利的。死亡者较长的住院时间（LOS）是非常不盈利的（住院时间超过60天的死亡者每位患者产生20210美元的亏损）。与非急诊死亡者相比，急诊胃肠病入院死亡者在DRG下的财务风险更大。与未转诊的死亡者相比，那些从其他临床科室转诊至胃肠病科的死亡者在DRG下往往具有更高的资源利用率和财务风险。这些数据表明，当前DRG前瞻性支付系统在胃肠病死亡病例方面存在明显的不公平性。胃肠病死亡者医院资源利用增加的预测变量包括更长的住院时间、急诊入院以及从另一个临床科室转诊。如果联邦政府不改善DRG支付的公平性，某些可能死亡的患者群体未来可能会在医疗服务的可及性和/或质量方面出现下降。
