Ginsberg G, Lerner Y, Mark M, Popper M
Division of Information and Computing, Ministry of Health, Jerusalem, Israel.
Soc Sci Med. 1997 Mar;44(5):623-33. doi: 10.1016/s0277-9536(96)00214-6.
A two-part demand model based on data from a psychiatric case registry was estimated in order to search for predictors of hospital-based psychiatric care utilization. Using only age as an independent variable, explanation of future resource utilization is considerably weaker than when number of cumulative days of psychiatric hospital-based service use during the previous five years is also included. Only a small marginal gain is achieved by also adding diagnoses. Prospective remuneration by capitating sick funds according to age and past hospital-based service utilization records is recommended to avoid the twin pitfalls of cream-skimming and a distorted allocation of resources for psychiatric services.
为了寻找基于医院的精神科护理利用的预测因素，我们基于一个精神科病例登记处的数据估计了一个两部分需求模型。仅将年龄作为自变量时，对未来资源利用的解释力明显弱于同时纳入前五年基于医院的精神科服务使用的累计天数时的情况。加入诊断因素仅能带来少量的边际收益。建议根据年龄和过去基于医院的服务利用记录对疾病基金进行按人头付费的前瞻性支付，以避免筛选优质客户和精神科服务资源分配扭曲这两个陷阱。
