Medical care review最新文献

英文中文

Uncompensated hospital care. 无偿住院治疗。

Medical care review

Pub Date : 1992-01-01 DOI: 10.1177/002570879204900302

R P Duncan

引用次数: 25

Editorial Foreword 编辑前言

Medical care review

Pub Date : 1991-12-01 DOI: 10.1177/002570879104800401

T. Rundall

引用次数: 0

Editorial Foreword 编辑前言

Medical care review

Pub Date : 1991-09-01 DOI: 10.1177/002570879104800301

T. Rundall

引用次数: 0

Editorial Foreword 编辑前言

Medical care review

Pub Date : 1991-06-01 DOI: 10.1177/002570879104800201

T. Rundall

引用次数: 0

Editorial Foreword 编辑前言

Medical care review

Pub Date : 1991-03-01 DOI: 10.1177/002570879104800101

T. Rundall

引用次数: 0

The process of choice of health care plan and provider: development of an integrated analytic framework. 选择医疗保健计划和提供者的过程:综合分析框架的发展。

Medical care review

Pub Date : 1991-01-01 DOI: 10.1177/002570879104800304

M S Klinkman

引用次数: 24

Assessing Medicare's prospective payment system for hospitals. 评估医疗保险对医院的预期支付系统。

Medical care review

Pub Date : 1991-01-01 DOI: 10.1177/002570879104800203

G S Chulis

The Medicare prospective payment system for hospitals was created to slow the growth of government spending on health care. This analysis has shown that the program has accomplished its cost-containment objective in the first five years of its existence. The average length of hospital stay has dropped sharply under PPS, reducing hospital costs. These reduced costs combined with payments based on higher pre-PPS historic costs have given hospitals high profits in the early years of PPS. One of the expected but unwanted outcomes, more admissions, has never occurred. The unexpected rop in admissions under PPS has been responsible for government savings on Medicare inpatient care. Although Medicare outpatient hospital and physician expenditures have grown at fast rates during PPS, there is no evidence in aggregate date that they have grown any faster because of inpatient care shifting to avoid PPS payment controls. The Medicare PPS savings have extended to all U.S. hospital spending, which has grown at much slower rates since the implementation of PPS. There have also been negative outcomes from PPS, and some questions posed about PPS remain unanswered. The inflation in "DRG creep" or upcoding that was predicted for PPS did occur. The government has since washed much of this code inflation out of the permanent payment base, but this phenomenon may not be a self-limiting problem, as was widely hoped. To date there is no convincing evidence of poorer quality of care under PPS, but most of the available evidence is based on mortality studies, which have limited use in measuring changes in quality of care. While PPS has helped to slow the growth in Medicare and national hospital spending, it has not had an appreciable effect on the rate of growth in the nation's total health spending. Although it was unintended, PPS has been providing a natural experiment on the issue of whether increased cost sharing dampens demand for health care services. By slowing the growth rate of inpatient hospital spending, PPS has increased the share of Medicare spending under SMI, where beneficiaries have higher coinsurance. The short-run beneficiary response appears to be an increase in demand for Medi-gap health insurance rather than a dampening of demand for services. To this point it appears that Medicare's PPS has been successful in containing the growth in hospital costs while avoiding, or managing, unwanted consequences. (ABSTRACT TRUNCATED AT 400 WORDS)

针对医院的医疗保险预期支付系统的建立是为了减缓政府在医疗保健方面支出的增长。这一分析表明，该方案在其存在的头五年内实现了其成本控制目标。在保福利制度下，平均住院时间大幅缩短，降低了医院成本。这些降低的成本加上基于保付计划实施前较高历史成本的支付，使医院在保付计划实施的最初几年获得了高额利润。预期但不希望看到的结果之一——更多的招生——从未发生过。PPS下住院人数的意外下降是政府在医疗保险住院护理上节省开支的原因。尽管医疗保险门诊医院和医生支出在PPS期间增长速度很快，但没有证据表明，由于住院治疗转移以避免PPS支付控制，它们的增长速度更快。医疗保灵计划的储蓄已经扩展到美国所有医院的开支，自从实行保灵计划以来，医院开支的增长速度要慢得多。PPS也有负面的结果，一些关于PPS的问题仍然没有答案。“DRG蠕变”的膨胀或对PPS的预测的升级确实发生了。自那以来，政府已将这种代码通胀的大部分从永久性支付基础中剔除，但这种现象可能不会像人们普遍希望的那样是一个自我限制的问题。迄今为止，没有令人信服的证据表明PPS的护理质量较差，但大多数现有证据都是基于死亡率研究，这些研究在衡量护理质量变化方面的作用有限。虽然PPS有助于减缓医疗保险和国家医院支出的增长，但它对国家总医疗支出的增长率没有明显的影响。虽然这是无意的，但PPS在增加费用分摊是否会抑制对保健服务的需求这一问题上提供了一个自然的实验。通过减缓住院病人医院支出的增长率，PPS增加了SMI下医疗保险支出的份额，其中受益人有更高的共同保险。受益人的短期反应似乎是增加对中等差距医疗保险的需求，而不是减少对服务的需求。在这一点上，医疗保险的PPS似乎已经成功地控制了医院成本的增长，同时避免或管理了不想要的后果。(摘要删节为400字)

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引用次数: 62

The organization and the injured worker. 组织和受伤工人。

Medical care review

Pub Date : 1991-01-01 DOI: 10.1177/002570879104800404

M M Hogan

引用次数: 0

Changing our health care system. 改变我们的医疗保健系统。

Medical care review

Pub Date : 1991-01-01 DOI: 10.1177/002570879104800302

D Mechanic

引用次数: 3

Interorganizational theory and research: implications for health care management, policy, and research. 组织间理论和研究:对卫生保健管理、政策和研究的影响。

Medical care review

Pub Date : 1991-01-01 DOI: 10.1177/002570879104800402

S Sofaer, R C Myrtle

引用次数: 34

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