Muñoz E, Tortella B J, Jaker M, Sakmyster M, Kanofsky P
Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey (UMDNJ), Newark.
Surgery. 1994 Apr;115(4):411-6.
Health care costs continue to spiral; aggregate costs for 1992 are $850 billion, 13.6% of the U.S. gross national product. The issue has assumed national proportions, and change appears to be on the federal agenda. Great interest in surgical expenditures exists, which comprise 30.1% of all health care outlays.
We analyzed 13,600 general surgical patients in eight teaching hospitals in New Jersey during 1988. Hospital resource consumption was measured for hospital length of stay, hospital cost per patient, race, gender, diagnoses and procedures, and mortality rate.
Surgical patients at these medical centers had a mean hospital cost per patient of $8,193, mean hospital length of stay of 12.4 days, an emergency admission rate of 40.4%, and a mortality rate of 6.0%. Emergency admissions had higher costs compared with nonemergencies ($11,717 vs $5,804, p < 0.001) and a poorer outcome (11.2% mortality rate vs 2.6%, p < 0.01). Patients who died had a higher hospital cost per patient compared with survivors ($29,314 vs $6,837, p < 0.001) and a higher emergency admission rate (74.7% vs 38.2%, p < 0.001).
Changes to the surgical delivery system will occur during the next decade. This study showed factors associated with higher hospital costs for surgical patients; changing reimbursement systems must recognize these characteristics for surgical patients in teaching hospitals. Factors associated with emergency admission and mortality, once identified, could be used to improve the health delivery system that affects surgical patients.
医疗保健费用持续攀升；1992年的总费用为8500亿美元，占美国国民生产总值的13.6%。这个问题已上升到全国层面，变革似乎已提上联邦议程。人们对手术费用极为关注，手术费用占所有医疗保健支出的30.1%。
我们分析了1988年新泽西州8家教学医院的13600例普通外科手术患者。对住院时间、每位患者的住院费用、种族、性别、诊断和手术方式以及死亡率等医院资源消耗情况进行了测量。
这些医疗中心的手术患者平均每位患者的住院费用为8193美元，平均住院时间为12.4天，急诊入院率为40.4%，死亡率为6.0%。与非急诊患者相比，急诊患者费用更高（11717美元对5804美元，p<0.001），且预后更差（死亡率11.2%对2.6%，p<0.01）。与存活患者相比，死亡患者平均每位患者的住院费用更高（29314美元对6837美元，p<0.001），急诊入院率也更高（74.7%对38.2%，p<0.001）。
未来十年手术服务系统将会发生变革。本研究显示了与手术患者住院费用较高相关的因素；不断变化的报销系统必须认识到教学医院手术患者的这些特征。一旦确定与急诊入院和死亡率相关的因素，就可用于改善影响手术患者的医疗服务系统。
