Pauly M V, Erder M H
Wharton School, University of Pennsylvania, Philadelphia 19104.
Health Serv Res. 1993 Feb;27(6):813-39.
This study is an attempt to address both the extent to which surgical procedures on an outpatient basis substitute cost-effectively for inpatient procedures, and whether or not an insurance policy's financial incentives increase the volume of outpatient surgical procedures. In particular, given an insurance product of a given composition: What is the probability that the insured will have surgery? and if a surgery does take place, what is the probability that it will occur in an outpatient setting? Finally, the article assesses the implication of such products on the total cost of care by quantifying the insurance plans along two parameters, the relative user price for outpatient versus inpatient surgery and the absolute price for the inpatient surgery. The results indicate that insurance policies that offer relatively lower out-of-pocket payments for ambulatory surgery do not increase the probability that surgery will be done in the ambulatory setting. However, higher out-of-pocket payments for surgery, regardless of site, do reduce the surgery rate. There are other patient and market characteristics, especially the availability of freestanding surgery firms, that do influence the location of surgery.
本研究旨在探讨门诊手术在多大程度上能以成本效益高的方式替代住院手术，以及保险政策的经济激励措施是否会增加门诊手术的数量。具体而言，对于某一特定构成的保险产品：被保险人进行手术的概率是多少？如果进行手术，在门诊环境中进行手术的概率是多少？最后，本文通过对保险计划的两个参数进行量化，即门诊手术与住院手术的相对用户价格以及住院手术的绝对价格，来评估此类产品对医疗总费用的影响。结果表明，为门诊手术提供相对较低自付费用的保险政策不会增加在门诊环境中进行手术的概率。然而，无论手术地点如何，较高的手术自付费用确实会降低手术率。还有其他患者和市场特征，特别是独立手术公司的可用性，确实会影响手术地点。
