Muñoz E, Sterman H, Goldstein J, Friedman R, Cohen J, Wise L
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 11042.
Am Surg. 1988 Sep;54(9):535-8.
Hospitals face increasing uncertainty under prospective payment systems such as Medicare's DRG system. We analyzed the equity of the DRG system for 2622 Medicare surgical patients in the 82 non-age stratified surgical DRGs. Patients age 70 and over had higher total hospital costs (P less than .05), a longer hospital length of stay, more diagnoses per patient, losses under DRG payment (P less than .01), a greater percentage of outliers (P less than .05) and higher mortality than patients in these same DRGs under 70 years of age. This data suggests that the current DRG classification scheme may be inequitable vis-a-vis older Medicare patients in the non-age stratified surgical DRGs, and could provide financial disincentives that limit both their access and quality of care in the future.
在诸如医疗保险的诊断相关分组（DRG）系统等前瞻性支付系统下，医院面临着越来越大的不确定性。我们分析了82个非年龄分层手术DRG中2622名医疗保险手术患者的DRG系统公平性。70岁及以上的患者总住院费用更高（P小于0.05），住院时间更长，每位患者的诊断更多，在DRG支付下出现亏损（P小于0.01），异常值百分比更高（P小于0.05），且死亡率高于这些相同DRG中70岁以下的患者。这些数据表明，当前的DRG分类方案相对于非年龄分层手术DRG中的老年医疗保险患者可能不公平，并可能在未来提供经济上的抑制因素，限制他们获得医疗服务的机会和医疗质量。
