AP-HP, Hôtel Dieu, URC Eco Ile-de-France, Paris, France; AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France.
AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France; French National Institute of Health and Medical Research, Clinical Investigation Centers, CIC, Paris, France.
Value Health. 2020 Mar;23(3):335-342. doi: 10.1016/j.jval.2019.10.008. Epub 2019 Dec 4.
Studies have shown a consistent impact of socioeconomic status at birth for both mother and child; however, no study has looked at its impact on hospital efficiency and financial balance at birth, which could be major if newborns from disadvantaged families have an average length of stay (LOS) longer than other newborns. Our objective was therefore to study the association between socioeconomic status and hospital efficiency and financial balance in that population.
A study was carried out using exhaustive national hospital discharge databases. All live births in a maternity hospital located in mainland France between 2012 and 2014 were included. Socioeconomic status was estimated with an ecological indicator and efficiency by variations in patient LOS compared with different mean national LOS. Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level by the difference in aggregated revenues and production costs for said hospital. Multivariate regression models studied the association between those indicators and socioeconomic status.
A total of 2 149 454 births were included. LOS was shorter than the national means for less disadvantaged patients and longer for the more disadvantaged patients, which increased when adjusted for gestational age, birth weight, and severity. A 1% increase in disadvantaged patients in a hospital's case mix significantly increased the probability that the hospital would be in deficit by 2.6%.
Reforms should be made to hospital payment methods to take into account patient socioeconomic status so as to improve resource allocation efficiency.
已有研究表明，母亲和儿童在出生时的社会经济地位存在一致影响；然而，尚无研究关注其对出生时医院效率和财务平衡的影响，如果来自弱势家庭的新生儿的平均住院时间（LOS）长于其他新生儿，则这种影响可能会很大。因此，我们的目的是研究该人群中社会经济地位与医院效率和财务平衡之间的关联。
使用详尽的国家医院出院数据库进行了一项研究。纳入 2012 年至 2014 年期间位于法国大陆的一家产科医院的所有活产儿。社会经济地位采用生态指标进行估计，效率通过患者 LOS 与不同平均国家 LOS 的变化来衡量。财务平衡在入院水平上通过生产成本和收入的比率以及通过汇总该医院的收入和生产成本差异在医院水平上进行评估。多元回归模型研究了这些指标与社会经济地位之间的关联。
共纳入 2149454 例分娩。与不太弱势的患者相比，弱势患者的 LOS 短于全国平均值，而与更弱势的患者相比，LOS 则更长，调整胎龄、出生体重和严重程度后则更长。医院病例组合中弱势患者的比例增加 1%，则医院出现亏损的概率显著增加 2.6%。
应改革医院支付方式，以考虑患者的社会经济地位，从而提高资源分配效率。
