Munoz E, Johnson H, Margolis I, Ratner L, Mulloy K, Wise L
Long Island Jewish Medical Center, New Hyde Park, New York 11042.
Orthopedics. 1988 Dec;11(12):1645-51. doi: 10.3928/0147-7447-19881201-06.
The federal Medicare Diagnostic Related Group (DRG) hospital reimbursement system has been on line for 5 years. Hospitals contend that profit margins have dropped to dangerously low levels, due to the federal DRG Prospective Payment System. The authors analyzed all orthopedic surgical admissions to a large academic medical center under DRG reimbursement and characterized patients by age, resource utilization, and outcome. Total costs for the 1,040 orthopedic patients analyzed during a 15-month period added up to $9,718,800. Mean hospital cost per patient, mean hospital length of stay, percent outliers, and mortality generally increased with age. All age categories of patients 65 years of age and above generated financial losses under DRGs. Older orthopedic patients consumed a disproportionately larger share of resources than younger patients, and were more frequent users of the SICU and blood. The current DRG reimbursement scheme may be inequitable in relation to the older orthopedic surgery patient. If these findings are demonstrated at other medical centers, older orthopedic surgical patients could be limited in both their access and quality of care in the future.
联邦医疗保险诊断相关分组（DRG）医院报销系统已上线5年。医院声称，由于联邦DRG预期支付系统，利润率已降至危险的低水平。作者分析了在DRG报销制度下一家大型学术医疗中心的所有骨科手术入院病例，并按年龄、资源利用情况和治疗结果对患者进行了分类。在15个月期间分析的1040名骨科患者的总成本总计为9718800美元。每位患者的平均住院费用、平均住院天数、异常值百分比和死亡率通常随年龄增长而增加。65岁及以上的所有年龄段患者在DRG制度下均产生了财务亏损。老年骨科患者比年轻患者消耗了不成比例的更多资源，并且更频繁地使用外科重症监护病房（SICU）和血液。当前的DRG报销方案对于老年骨科手术患者可能不公平。如果这些发现在其他医疗中心得到证实，未来老年骨科手术患者在就医机会和医疗质量方面可能都会受到限制。
