Zweifel P
Soc Sci Med. 1985;21(10):1139-51. doi: 10.1016/0277-9536(85)90172-8.
Health insurers fear that increased use of medical technology in ambulatory care results in increased billings per physician. This view may overlook certain subtle links between available, appropriated technology in ambulatory practice and the propensity to hospitalize a marginal patient. In this paper, the impacts of technology on four components of total per physician treatment cost were analyzed statistically using 1976-1978 percentage changes for a sample of more than 700 Swiss physicians: number of cases treated, per case billings for ambulatory care, rate of hospitalization and cost of a hospital stay relative to ambulatory care. On net, a 10% reduction in use of laboratory work and X-ray procedures was estimated to result in about 2 and 0.4% savings, respectively. A similar reduction of direct drug sales to patients would increase total cost by 0.3%. From the vantage point of society, even the modest savings indicated probably disappear as soon as the full social cost of a hospital stay is taken into account.
健康保险公司担心，门诊医疗中医疗技术使用的增加会导致每位医生的账单增加。这种观点可能忽略了门诊实践中可用的、合适的技术与将边缘患者住院的倾向之间的某些微妙联系。在本文中，使用700多名瑞士医生样本的1976 - 1978年百分比变化，对技术对每位医生总治疗成本的四个组成部分的影响进行了统计分析：治疗病例数、门诊医疗的每例账单、住院率以及相对于门诊医疗的住院费用。总体而言，估计实验室检查和X光检查使用量减少10%分别会节省约2%和0.4%。向患者直接药品销售的类似减少会使总成本增加0.3%。从社会的角度来看，一旦考虑到住院的全部社会成本，即使是所显示的适度节省可能也会消失。
