Rogers F B, Osler T M, Shackford S R, Cohen M, Camp L
University of Vermont, College of Medicine, Department of Surgery, Burlington 05405, USA.
J Trauma. 1997 Jul;43(1):65-72; discussion 72-3. doi: 10.1097/00005373-199707000-00016.
The financial plight of the urban trauma center is well documented. However, the financial status of the rural trauma center is largely unknown. We hypothesized that our rural trauma center with a high number of blunt trauma patients, a wide spectrum of injury severity, and a large percentage of insured patients would prove to be financially advantageous to the institution. From January 1994 to June 1995, 1,119 consecutive trauma admissions had a complete financial profile compiled including actual costs, reimbursements, and reimbursement ratio (RR = reimbursement/actual costs). Our injury severity profile was very skewed with a preponderance of less severely injured patients (mean Injury Severity Score = 9.6 +/- 7.8). The payor profile of these patients included 49.2% fee-for-service (RR = 1.43), 25.4% diagnosis-related group-based (RR = 0.92), 8.77% per diem (RR = 0.51), and 1.25% capitated (RR = 0.47). Overall, the RR for the trauma unit was 1.11, representing a net profit overall. Cost closely tracked both hospital and intensive-care unit length of stay (R2 = 0.925). Likewise, reimbursement also was reflected in both hospital and intensive-care unit length of stay (R2 = 0.735). We conclude that our rural trauma center, with a favorable payor mix and low injury severity, is financially profitable.
城市创伤中心的财务困境有充分的文献记载。然而，农村创伤中心的财务状况在很大程度上却无人知晓。我们推测，我们的农村创伤中心接收大量钝性创伤患者，损伤严重程度范围广，且参保患者比例高，对该机构来说在财务上会是有利可图的。从1994年1月至1995年6月，对连续1119例创伤入院患者编制了完整的财务档案，包括实际成本、报销金额及报销率（报销率=报销金额/实际成本）。我们的损伤严重程度分布非常不均衡，轻伤患者占多数（平均损伤严重程度评分=9.6±7.8）。这些患者的付款人构成包括49.2%的按服务收费（报销率=1.43）、25.4%的按诊断相关分组付费（报销率=0.92）、8.77%的按日计费（报销率=0.51）和1.25%的预付费（报销率=0.47）。总体而言，创伤科的报销率为1.11，总体上代表着净利润。成本与医院及重症监护病房的住院时间密切相关（R2=0.925）。同样，报销情况也体现在医院及重症监护病房的住院时间上（R2=0.735）。我们得出结论，我们的农村创伤中心付款人构成有利且损伤严重程度低，在财务上是盈利的。
