Ghodse B
St George's Healthcare Trust, St George's Hospital, London.
BMJ. 1995 Jun 17;310(6994):1573-6. doi: 10.1136/bmj.310.6994.1573.
To describe the extracontractual referrals of residents of a health authority during a six month period in 1994, identifying the number and cost of emergency and non-emergency referrals, including the number of cases costing more than 20,000 pounds and those cases when payment was refused.
Descriptive analysis of all extracontractual referrals submitted to the health authority between 1 April and 30 September 1994.
A health authority covering a population of 614,000.
Payment of 2,583,693 pounds was made to 263 different providers for 2400 episodes of care, of which 1469 were emergencies and 931 were elective or tertiary referrals. Authorisation was granted for an additional 1376 referrals for future treatment but was refused in 713 instances, mostly for technical reasons. Sixteen extracontractual referrals together accounted for over a fifth of total expenditure during the study period.
Handling large numbers of episodes of care on an individual cost per case basis imposes an enormous administrative burden on both purchasers and providers, diverting money away from patient care. Extracontractual referrals also expose health authorities to considerable financial risk and may undermine commissioning strategies. Measures are proposed to limit the number of episodes handled in this way.
描述1994年某卫生当局辖区居民的非合同转诊情况，确定急诊和非急诊转诊的数量及费用，包括费用超过20000英镑的病例数量以及被拒付费用的病例情况。
对1994年4月1日至9月30日期间提交给该卫生当局的所有非合同转诊进行描述性分析。
一个覆盖614000人口的卫生当局。
向263个不同的医疗机构支付了2583693英镑，用于2400次医疗服务，其中1469次为急诊，931次为择期或三级转诊。另外1376次转诊获得了未来治疗的授权，但有713次被拒付，主要是出于技术原因。16次非合同转诊占研究期间总支出的五分之一以上。
按病例逐个计算费用来处理大量医疗服务会给购买方和提供方带来巨大的行政负担，使资金从患者护理中转移。非合同转诊也使卫生当局面临相当大的财务风险，并可能破坏委托策略。建议采取措施限制以这种方式处理的服务次数。
