Murtaugh C M, Cooney L M, DerSimonian R R, Smits H L, Fetter R B
Yale School of Medicine, Yale University.
Health Serv Res. 1988 Oct;23(4):467-93.
Most public funding methods for long-term care do not adequately match payment rates with patient need for services. Case-mix payment systems are designed to encourage a more efficient and equitable allocation of limited health care resources. Even nursing home case-mix payment systems, however, do not currently provide the proper incentives to match rehabilitation therapy resources to a patient's needs. We were able to determine by a review of over 8,500 patients in 65 nursing homes that certain diagnoses, partial dependence in activities of daily living (ADLs), clear mental status, and improving medical status are associated with the provision of rehabilitation services to nursing home residents. These patient characteristics are clinically reasonable predictors of the need for therapy and should be considered for use in nursing home case-mix reimbursement systems. Primary payment source also was associated with the provision of rehabilitation services even after taking into account significant patient characteristics. It is unclear how much of the variation in service use across payers is due to differences in patient need as opposed to differences in the financial incentives associated with current payment methods.
大多数长期护理的公共资金筹集方式未能使支付费率与患者的服务需求充分匹配。病例组合支付系统旨在促进有限医疗资源更高效、公平地分配。然而，即使是养老院病例组合支付系统，目前也未提供适当激励措施，以使康复治疗资源与患者需求相匹配。通过对65家养老院的8500多名患者进行审查，我们发现某些诊断结果、日常生活活动（ADL）部分依赖、精神状态清晰以及病情好转与向养老院居民提供康复服务相关。这些患者特征是治疗需求的临床合理预测指标，应考虑用于养老院病例组合报销系统。即使在考虑了重要的患者特征之后，主要支付来源也与康复服务的提供有关。目前尚不清楚不同支付方之间服务使用差异有多少是由于患者需求不同，而非当前支付方式相关的财务激励差异所致。
