Rupp A, Steinwachs D M, Salkever D S
Arch Gen Psychiatry. 1985 Jun;42(6):552-5. doi: 10.1001/archpsyc.1985.01790290030003.
We examined the extent to which inpatient care for patients with mental disorders in general, acute care hospitals responds differently to two types of prospective hospital payment. In Maryland, hospitals have been regulated since 1976 under two forms of payment based on per-service and per-case definitions of hospital output. The study utilizes a 20% sample of 58,000 mental-disorder discharges from 21 per-case- and 24 per-service-reimbursed hospitals in Maryland between fiscal years 1977 and 1980. The effects of payment method on length of stay are examined through the application of multivariate regression models. The empirical results are generally consistent with the notion that the per-case payment method provides some incentives for hospitals to reduce the length of stay. The regulatory effects, however, vary with patient characteristics, particularly by diagnosis.
我们研究了综合急症医院中精神障碍患者的住院护理对两种类型的前瞻性医院支付方式的反应差异程度。在马里兰州，自1976年以来，医院一直按照基于医院产出的每项服务和每个病例定义的两种支付形式进行监管。该研究使用了1977财年至1980财年期间马里兰州21家按病例报销和24家按服务报销医院的58000例精神障碍出院病例的20%样本。通过应用多元回归模型来检验支付方式对住院时间的影响。实证结果总体上与按病例支付方式为医院提供了一些缩短住院时间的激励措施这一观点一致。然而，监管效果因患者特征而异，尤其是按诊断情况。
