Tamura H, Lauer L W, Sanborn F A
Health Serv Res. 1985 Apr;20(1):27-42.
A multiple regression method of defining "reasonable cost" for Medicaid reimbursement of nursing home patient care was implemented in Washington State in July 1978. A patient-mix index, the Katz ADL (Activities of Daily Living), was included in the regression equation as one of the independent variables to allow systematically for individual patient characteristics and needs in the rate-setting method. From the six measures investigated, the Katz ADL index was selected as the best predictor of patient care per patient-day cost. The way a "reasonable cost interval" of patient care per patient-day was established for each of 277 providers is described. Evidence is presented that this statistical rate-setting method contained efficiency incentives. The potential usefulness of such methods in obtaining management information at low cost should be given more consideration in efforts to reduce administrative costs of governmental health care programs, thus allocating scarce resources to patients on an equitable basis.
1978年7月，华盛顿州实施了一种多元回归方法，用于确定医疗补助计划中疗养院患者护理的“合理成本”。在回归方程中纳入了一个患者组合指数——卡茨日常生活活动能力量表（Katz ADL），作为自变量之一，以便在费率设定方法中系统地考虑个体患者的特征和需求。在所研究的六项指标中，卡茨ADL指数被选为每位患者每日护理成本的最佳预测指标。文中描述了为277家医疗机构中的每一家确定每位患者每日护理“合理成本区间”的方法。有证据表明，这种统计费率设定方法包含了效率激励因素。在努力降低政府医疗保健项目的行政成本，从而在公平的基础上为患者分配稀缺资源的过程中，应更多地考虑此类方法在低成本获取管理信息方面的潜在用途。
