保险业和康复服务的覆盖面。

R A Breed
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引用次数: 0

摘要

康复设施不可避免地卷入正在进行的关于卫生保健服务的筹资和提供的全国辩论。在涉及我们的设施的辩论中,相对较小的一部分并没有涉及对严重创伤或疾病的康复医学需求的质疑,而是围绕如何最好地提供服务以及对固有成本的成本控制展开讨论。一些人认为,政府最近对DRG和相关的预期付款计划表现出的兴趣有效地减缓了医疗保健费用的增长。我们相信,如果仔细观察这些数字,就会发现成本“节约”只不过是将成本转移给了私人支付者。我们认为,如果DRG计划严格适用于康复机构,其结果可能对机构和患者都有害。我们正在探索潜在的新市场,例如我们的设施可以在治疗由第三方疏忽造成的灾难性伤害方面发挥作用。涉及人身伤害的责任诉讼是国家及其责任保险公司非常关注的一个领域,最近媒体对“责任保险危机”的关注日益增加就是明证。康复设施治疗的长期成本控制效果明显,这吸引了责任保险公司的注意,认为这是减轻责任风险的一种潜在手段。利润驱动的医疗保健公司的出现以及随之而来的巨大竞争是需要考虑的最重要的发展之一。(摘要删节250字)
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The insurance industry and the coverage of rehabilitation services.

Rehabilitation facilities are inescapably involved in the ongoing national debate over the financing and delivery of health care services. The relatively small portion of the debate involving our facilities does not involve questioning the need for rehabilitative medicine in serious trauma or illness, rather, the discussion revolves around how the services can best be delivered and the cost containment of the inherent costs. The recent interest evidenced by the government in DRG and related prospective payment plans is credited by some with effectively slowing the increase in health care costs. We believe that a careful look beyond just the numbers could demonstrate that cost "savings" are simply cost shifting to private payers. We believe that if DRG plans are strictly applied to rehabilitation facilities the results could be detrimental to both the facilities and their patients. Potential new markets are being explored such as the role our facilities can play in the area of treatment of catastrophic injury resulting from third party negligence. Liability litigation involving bodily injury is an area of enormous concern for the nation and its liability insurers, as is evidenced by the increased media attention given to the "liability insurance crisis" recently. The obvious long term cost containment effects of treatment in rehabilitation facilities is attracting the attention of the liability insurers as a potential vehicle by which liability exposures can be mitigated. The emergence of profit driven health care corporations and the enormous competition accompanying it is one of the most significant developments to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

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