Eastaugh S R
Health Serv Res. 1979 Winter;14(4):290-308.
Measures of surgical utilization studied are the number of elective tests performed preoperatively and the total cost per case. The unit of analysis is a matched pair of patients who underwent the same elective procedure, one a Veterans Administration patient, and the other a municipal or voluntary hospital patient. Federal ownership of the hospital ahd the strongest impact on tests and cost per case. On average, costs for the VA patients were 52 percent more per case. The foreign medical graduate variable had a large positive (inflationary) effect on the number of tests, but a slight downward influence in the cost regressions. The fraction of surgeons with faculty appointments had a strong negative (curtailing) impact on elective testing, but an upward influence on cost per case. Additional variables such as age, average laboratory turnaround time, and fraction of the medical school's students doing their surgical clerkship at the hospital ahd a slight upward influence on utilization. The three policy issues raised in the study involve changing the hospital reimbursement incentives, targeting continuing education programs to categories of staff that need it most, and redistributing faculty and students.
所研究的手术利用率指标包括术前进行的择期检查数量和每例病例的总成本。分析单位是一对接受相同择期手术的匹配患者，其中一名是退伍军人管理局的患者，另一名是市立或志愿医院的患者。医院的联邦所有制对检查和每例病例成本的影响最大。平均而言，退伍军人管理局患者的每例成本高出52%。外国医学毕业生变量对检查数量有很大的正向（通胀）影响，但在成本回归中影响略有下降。有教职任命的外科医生比例对择期检查有强烈的负向（抑制）影响，但对每例病例成本有正向影响。年龄、平均实验室周转时间以及在该医院进行外科实习的医学院学生比例等其他变量对利用率有轻微的正向影响。该研究中提出的三个政策问题包括改变医院报销激励措施、针对最需要的员工类别开展继续教育项目以及重新分配教职人员和学生。
