Broyles R S, Tyson J E, Swint J M
University of Texas Southwestern Medical Center at Dallas, Department of Pediatrics, Dallas, Texas, USA.
Pediatrics. 1997 Mar;99(3):E8. doi: 10.1542/peds.99.3.e8.
Despite uncertain validity as a measure of cost, Medicaid reimbursements may be used to compare the costs of different pediatric interventions. We explored the credibility of Medicaid reimbursements as a measure of the costs of inpatient care associated with two different approaches to follow-up care for high-risk indigent infants.
Analysis of Medicaid reimbursements within a randomized trial of primary follow-up care.
Infants </=1500 g at birth in a large county hospital (Parkland Memorial Hospital).
Conventional care after nursery discharge (with well-baby care and care for chronic illnesses provided in our follow-up clinic) or primary care (with care for acute illnesses also provided in the follow-up clinic). Measures to prevent a lapse in Medicaid coverage were included in all clinic visits.
The completeness, comparability, and plausibility of Medicaid reimbursements for inpatient care of the two groups between nursery discharge and 1 year adjusted age.
A high percentage (90% to 91%) of both groups were enrolled in Medicaid. However, with fewer clinic visits in the conventional care group, Medicaid coverage often lapsed in this group, particularly among the highest risk infants. As a result, the proportion of hospital days reimbursed by Medicaid was substantially lower for conventional care than primary care infants (53% [92/174] vs 96% [298/310]). An even larger disparity was observed for pediatric intensive care days (10% [6/61] vs 100% [33/33]). Implausible Medicaid reimbursements included a lower reimbursement rate per day in the pediatric intensive care unit than on the pediatric floor (1 infant), a lower reimbursement rate per day for hospital care than home care (1 infant), and a mean reimbursement rate per day for our private pediatric teaching hospital ($1244/day) that did not exceed that for the private nonteaching pediatric hospital ($1268/day). The reimbursement rate for our public teaching hospital was particularly low ($507/day) despite a high acuity of illness (21% of hospital days in the pediatric intensive care unit).
Without proper validation, reimbursements from Medicaid (or any program that replaces it) should not be assumed to provide an unbiased or acceptably accurate measure of the relative or absolute cost of pediatric health care interventions.
尽管作为一种成本衡量指标的有效性尚不确定，但医疗补助报销可用于比较不同儿科干预措施的成本。我们探讨了医疗补助报销作为衡量与两种不同高危贫困婴儿后续护理方法相关的住院护理成本指标的可信度。
在一项初级后续护理随机试验中对医疗补助报销进行分析。
在一家大型县医院（帕克兰纪念医院）出生时体重≤1500克的婴儿。
出院后常规护理（在我们的后续诊所提供健康婴儿护理和慢性病护理）或初级护理（在后续诊所也提供急性病护理）。所有诊所就诊均包括防止医疗补助覆盖中断的措施。
两组婴儿出院至1岁校正年龄期间住院护理的医疗补助报销的完整性、可比性和合理性。
两组中很高比例（90%至91%）的婴儿参加了医疗补助。然而，由于常规护理组的诊所就诊次数较少，该组的医疗补助覆盖经常中断，尤其是在风险最高的婴儿中。结果，常规护理婴儿由医疗补助报销的住院天数比例显著低于初级护理婴儿（53%[92/174]对96%[298/310]）。在儿科重症监护天数方面观察到的差距甚至更大（10%[6/61]对100%[33/33]）。不合理的医疗补助报销包括儿科重症监护病房每天的报销率低于儿科普通病房（1名婴儿）、住院护理每天的报销率低于家庭护理（1名婴儿）以及我们的私立儿科教学医院每天的平均报销率（1244美元/天）不超过私立非教学儿科医院（1268美元/天）。尽管疾病严重程度较高（儿科重症监护病房占住院天数的21%），我们公立教学医院的报销率特别低（507美元/天）。
未经适当验证，不应假定医疗补助（或任何替代它的项目）的报销能提供儿科医疗保健干预相对或绝对成本的无偏或可接受的准确衡量指标。
