Menke T J, Ashton C M, Petersen N J, Wolinsky F D
Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center, Houston, TX 77030, USA.
Med Care. 1998 Aug;36(8):1126-37. doi: 10.1097/00005650-199808000-00003.
Although case-based payment is one of the main reimbursement mechanisms for hospitals, little is known about its effects in the general population. Prior studies have focused on Medicare or on all-payer systems in particular states. This study estimates the effect of a prospective payment system based on diagnosis-related groups (DRGs) nationwide in the Department of Veterans Affairs.
Multiple regression analysis was used to estimate the effect of Department of Veterans Affairs's diagnosis-related group system separately for 22 diagnoses. The dependent variables were length of stay, inpatient days per patient, and discharges per patient. Covariates included patient, hospital, and area characteristics.
Department of Veterans Affairs's diagnosis-related group system reduced lengths of stay and inpatient days per patient. The largest impacts were for the psychiatric diagnoses and several surgical procedures. The magnitudes of the effects were generally moderate. Department of Veterans Affairs's case-based system had a negligible effect on discharges per patient.
Per case reimbursement is a potentially useful tool for improving the efficiency of inpatient care for all types of diagnoses and age groups. The effect may be larger than estimated here because of institutional barriers and caps on financial impact.
尽管按病例付费是医院主要的报销机制之一，但对于其在普通人群中的影响却知之甚少。先前的研究主要集中在医疗保险或特定州的全支付者系统。本研究估计了退伍军人事务部全国范围内基于诊断相关分组（DRG）的前瞻性支付系统的影响。
采用多元回归分析分别估计退伍军人事务部诊断相关分组系统对22种诊断的影响。因变量为住院时间、每位患者的住院天数和每位患者的出院次数。协变量包括患者、医院和地区特征。
退伍军人事务部的诊断相关分组系统缩短了住院时间和每位患者的住院天数。对精神科诊断和几种外科手术的影响最大。影响程度一般适中。退伍军人事务部的按病例付费系统对每位患者的出院次数影响可忽略不计。
按病例报销是提高各类诊断和年龄组住院护理效率的潜在有用工具。由于制度障碍和财务影响上限，实际效果可能比此处估计的更大。
