Games Policy Makers and Providers Play: Introducing Case-Mix-Based Payment to Hospital Chronic Care Units in Japan
Games Policy Makers and Providers Play: Introducing Case-Mix-Based Payment to Hospital Chronic Care Units in Japan
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DOI：
10.1215/03616878-2009-003
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发表时间：
2009-06-01
影响因子：
4.2
通讯作者：
Ikegami, Naoki
中科院分区：
文献类型：
--
作者：
Ikegami, Naoki
日本为医院慢性护理单位制定了基于病例混合的支付方式，以取代每日固定费率，并鼓励医疗灵敏度较高的患者入院，这是使收费更加以证据为基础的政策举措的一部分。然而，尽管病人分组的标准是根据对资源使用情况的统计分析制定的，但由于总理决定减少卫生总支出和卫生部决定以减少慢性病护理单位为目标，因此，收费标准后来被设定为低于成本，特别是对于医疗敏锐度最低的群体。供应商很快适应了新的支付系统，主要是通过将患者重新分类到更高的医疗敏锐度组。一些医院报告尿路感染和压疮的患病率很高。作为回应，政府向医疗服务提供者发布指令，要求他们计算患病率，并记录对高危患者的强制性护理。然而，为了监测遵守情况并评估患者是否按照适当的病例组合组收费，政府必须投资开发一个全面的患者级数据库，并培训工作人员进行现场检查。
Case-mix-based payment was developed for hospital chronic care units in Japan to replace the flat per diem rate and encourage the admission of patients with higher medical acuity and was part of a policy initiative to make the tariff more evidence based. However, although the criteria for grouping patients were developed from a statistical analysis of resource use, the tariff was subsequently set below costs, particularly for the groups with the lowest medical acuity, both because of the prime minister's decision to decrease total health expenditures and because of the health ministry's decision to target the reductions on chronic care units. Providers quickly adapted to the new payment system mainly by reclassifying their patients to higher medical acuity groups. Some hospitals reported high prevalence rates of urinary tract infections and pressure ulcers. The government responded by issuing directives to providers to calculate the prevalence rates and document the care that has been mandated for the patients at risk. However, in order to monitor compliance and to evaluate whether the patient is being billed for the appropriate case-mix group, the government must invest in developing a comprehensive patient-level database and in training staff for making on-site inspections.