Harris B H, Bass K D, O'Brien M D
Division of Pediatric Surgery, Tufts University School of Medicine, New England Medical Center, Boston, MA, USA.
J Pediatr Surg. 1996 Jan;31(1):78-80; discussion 80-1. doi: 10.1016/s0022-3468(96)90323-1.
Despite the proven efficacy of pediatric trauma centers, their continued development is threatened by the perception that their cost exceeds the reimbursement for their services. The authors reviewed actual reimbursement for a group of pediatric trauma patients and compared with that for a group of appendectomy patients chosen to reflect the authors' surgical population at large.
The records of 209 consecutively treated trauma patients and 37 age-matched appendectomy patients treated in 1992 and 1993 were reviewed. Trauma patients were divided into two groups: moderate injury (ISS < or = 9; n = 134) and serious injury (ISS > or = 10; n = 75).
Hospital bills for the appendectomy patients were reimbursed at 72% of charges and 112% of costs. Payment was received at a mean of 36 days (range, 9 to 62 days) after discharge. Reimbursement for moderately injured patients was 104% of charges and 137% of costs and was received at a mean of 81 days (range, 3 to 270 days) after discharge. Six months postdischarge, reimbursement for seriously injured patients was 63% of charges and 86% of costs. Reimbursement was slow for some children who sustained severe injury, but as legal actions brought by patient's families were completed, open accounts were settled, and revenue in both groups totaled 76% of charges and 103% of costs 18 months postdischarge.
Hospital reimbursement for care at a level I pediatric trauma center exceeds 75% of charges and 100% of costs, no different from the overall rate for the general hospital surgical population. Analysis of reimbursement rates for trauma patients may be time-dependent.
尽管儿科创伤中心已被证实具有疗效，但其持续发展受到成本超过服务报销费用这一观念的威胁。作者回顾了一组儿科创伤患者的实际报销情况，并与一组为反映作者所在医院总体外科手术人群而选择的阑尾切除术患者的报销情况进行了比较。
回顾了1992年和1993年连续治疗的209例创伤患者以及37例年龄匹配的阑尾切除术患者的记录。创伤患者分为两组：中度损伤（损伤严重度评分[ISS]≤9；n = 134）和重度损伤（ISS≥10；n = 75）。
阑尾切除术患者的医院账单报销费用为收费的72%，成本的112%。出院后平均36天（范围9至62天）收到付款。中度损伤患者的报销费用为收费的104%，成本的137%，出院后平均81天（范围3至270天）收到报销。出院后6个月，重度损伤患者的报销费用为收费的63%，成本的86%。一些重伤儿童的报销速度较慢，但随着患者家属提起的法律诉讼结束、未结清账目得到解决，出院18个月后两组的收入总计为收费的76%，成本的103%。
一级儿科创伤中心的医院护理报销费用超过收费的75%和成本的100%，与综合医院外科手术人群的总体报销率没有差异。创伤患者报销率的分析可能与时间有关。
