Willemain T R
Health Serv Res. 1980 Winter;15(4):365-77.
The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term.
养老院服务付费的趋势一直是对患者进行更细致的区分以及确定其护理费用的报销率。差异化的极致是患者中心报销制，即每个患者的报销率都是单独确定的。本文介绍了一种用于比较替代报销方案潜在绩效的多付和少付模型。该模型用于将患者中心报销方法与病例组合报销法进行比较，后者根据养老院的病例组合为所有患者设定单一报销率。大致而言，当患者需求差异小于需求评估误差时，病例组合法更可取。由于目前在实践中似乎确实如此，因此短期内病例组合报销法似乎更可取。
