Costs, charges, and reimbursements for persons with sickle cell disease
Costs, charges, and reimbursements for persons with sickle cell disease
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DOI：
10.1097/00043426-199909000-00010
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发表时间：
1999-09-01
影响因子：
1.2
通讯作者：
Silverstein, MD
中科院分区：
文献类型：
--
作者：
Nietert, PJ;Abboud, MR;Silverstein, MD
目的：本研究的目的是描述镰状细胞病 (SCD) 患者的医疗保健成本和收费，并确定高使用率的预测因子。患者和方法：根据国际疾病分类第 9 版临床修改 (ICD-9-CM) 代码从 1996 年 1 月 1 日至 1997 年 9 月 30 日期间从大学医院的管理数据库中识别 SCD 患者。收集了所有医院每位患者的临床和管理数据 入院和门诊就诊。使用 Logistic 回归模型来确定高医疗保健使用率的预测因素。结果：总共确定了 947 名 SCD 患者，其中 73% 居住在南卡罗来纳州的三个县内。平均每名患者每年入院 0.9 次，门诊每名患者每年 8.0 次。每次入院的平均住院费用、医生费用和直接住院费用分别为 7290 美元、1589 美元和 5405 美元，平均住院时间为 4.5 天。每次门诊平均住院费用、医生费用和直接住院费用分别为 305 美元、169 美元和 688 美元。 40%的住院费用是由4.2%的患者承担的。研究发现，居住在遥远的县并因呼吸疼痛的诊断入院是超出预期报销的过高收费和开支的预测因素。结论：SCD 患者经常使用医疗保健服务。费用和成本在这些患者中的分配不成比例。住院费用过高的预测因素包括居住地距离医院较远以及入院时被诊断为呼吸困难。
Purpose: The aims of this study were to describe health care costs and charges for patients with sickle cell disease (SCD) and identify predictors of high use.Patients and Methods: Patients with SCD were identified by International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes from a university hospital's administrative databases from January 1, 1996, to September 30, 1997. Clinical and administrative data were gathered on each patient for all hospital admissions and ambulatory clinic visits. Logistic regression models were used to determine predictors of high health care use.Results: A total of 947 patients with SCD were identified, 73% of whom resided within three South Carolina counties. On average, there were 0.9 admissions per patient per year and 8.0 outpatient visits per patient per year. Mean inpatient hospital charges, physician charges, and direct hospital costs per admission were $7290, $1589, and $5405, respectively, and the average length of stay was 4.5 days. Mean hospital charges, physician charges, and direct hospital costs per outpatient visit were $305, $169, and $688, respectively. Forty percent of the inpatient hospital charges were accounted for by only 4.2% of the patients. Residing in a distant county and being admitted with a diagnosis of painful respiration were found to be predictors of excessive charges and expenses beyond expected reimbursements.Conclusions: Patients with SCD are frequent users of health care services. Charges and costs are distributed disproportionately across these patients. Predictors of excessive hospital charges include living geographically distant from the hospital and being admitted with a diagnosis of painful respiration.