Phelan P D, Tate R, Webster F, Marshall R P
Faculty of Health Sciences, La Trobe University, Melbourne, VIC.
Med J Aust. 1998 Oct 19;169(S1):S36-8.
Inadequate cost weights are a major problem in casemix funding systems. Clinicians should understand the basis for the cost weights underpinning the hospital payment system in their State and their own hospital. Clinician managers need valid patient costing data if they are to benchmark and improve cost-effectiveness while maintaining and enhancing quality. The cost model approach for determining cost weights has inherent limitations, and, the alternative, detailed patient costing, requires efficient hospital information technology systems. A simplified approach to patient costs, which uses existing hospital data systems, may be useful for smaller hospitals. A better classification system and funding formulas incorporating reliable cost weights derived from patient costing should overcome many of the deficiencies in the current casemix payments systems.
成本权重不足是病例组合资金系统中的一个主要问题。临床医生应了解其所在州及所在医院的医院支付系统所依据的成本权重基础。临床医生管理人员若要在维持和提高质量的同时进行成本效益基准分析并加以改进，就需要有效的患者成本核算数据。确定成本权重的成本模型方法存在固有局限性，而另一种方法即详细的患者成本核算则需要高效的医院信息技术系统。一种利用现有医院数据系统的简化患者成本核算方法可能对小型医院有用。一个更好的分类系统以及纳入源自患者成本核算的可靠成本权重的资金计算公式应能克服当前病例组合支付系统中的许多缺陷。
