Miller M E, Sulvetta M B
Urban Institute, Washington DC 20037, USA.
Inquiry. 1995 Summer;32(2):155-63.
Medicare hospital outpatient expenditures are growing rapidly. In response, Congress mandated implementation of a prospective payment system (PPS). The potential cost control effectiveness of a PPS is assessed in this paper by decomposing growth in charges into changes in beneficiaries, prices, case mix, encounters per beneficiary, services per encounter, and intensity per service. This paper examines aggregate growth rates and rates disaggregated by type of service, highlighting rapid growth in surgery and imaging services. Findings indicate that 69% of observed growth is attributable to factors that would be unaffected by an encounter-based PPS (i.e., beneficiaries, prices, case mix, and encounters per beneficiary). We conclude that effective cost containment may require implementation of direct volume controls in addition to a PPS.
医疗保险医院门诊支出增长迅速。作为应对措施，国会要求实施前瞻性支付系统（PPS）。本文通过将费用增长分解为受益人数、价格、病例组合、每位受益人的就诊次数、每次就诊的服务项目以及每项服务的强度变化，来评估PPS潜在的成本控制效果。本文研究了总体增长率以及按服务类型细分的增长率，突出了外科手术和影像服务的快速增长。研究结果表明，观察到的增长中有69%归因于基于就诊次数的PPS不会影响的因素（即受益人数、价格、病例组合和每位受益人的就诊次数）。我们得出结论，除了PPS之外，有效的成本控制可能还需要实施直接的量的控制。
