HOSPITAL COST CONTAINMENT IN THE 1980S - HARD LESSONS LEARNED AND PROSPECTS FOR THE 1990S
HOSPITAL COST CONTAINMENT IN THE 1980S - HARD LESSONS LEARNED AND PROSPECTS FOR THE 1990S
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DOI：
10.1056/nejm199104113241506
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发表时间：
1991-04-11
影响因子：
158.5
通讯作者：
MENDELSON, DN
中科院分区：
文献类型：
--
作者：
SCHWARTZ, WB;MENDELSON, DN
背景 20世纪80年代控制住院费用的一个关键战略是减少住院总人数和平均住院时间。 我们评估了所实现的节省的幅度，减少对成本增加率的影响，以及通过减少患者住院天数（住院天数）来实现未来节省的前景。 使用来自美国医院协会和医疗保健融资管理局的数据，我们计算了住院总天数的节省，作为每年住院天数历史增长的偏差。 然后，我们估计了如果住院天数没有减少的话，将会观察到的成本的真实的增加;我们将这个值定义为成本的“潜在”增长率。 最后，我们比较了医疗保险受益人和医疗保险未覆盖患者（非医疗保险患者）的医院报销增加率。 1981年至1988年期间，每年住院总天数总共减少了28%。 1984年和1985年的年度减少幅度最大，随后每年逐渐减少;到1988年，住院总天数几乎没有进一步减少。 1980年代中期费用增长的短暂减缓完全可归因于每年住院天数的减少。 因此，费用的基本增长率没有受到控制开支的努力的影响。 门诊次数的增加部分抵消了住院天数减少带来的节余。 即使在住院天数减少而节省的费用减少的情况下，这一增长也持续存在，而且在1980年代后期，这一增长几乎消除了任何美元节省。 从1976年到1982年，按真实的价格计算，医疗保险在急性护理医院提供的服务上的支出每年增长9.2%，而非医疗保险支出仅增长4.6%。 近年来，这种模式发生了逆转;在1987-1988年，医疗保险支出每年仅增长0.6%，而非医疗保险支出每年增长9%。 我们的研究结果表明，住院天数容易减少的时代，以及相关的成本上升的衰减，基本上已经结束。 如果进一步减少住院日数，同时增加类似于过去几年的非住院护理量，则节省的净费用可能微不足道。 一旦因减少不适当的住院天数而可能节省的费用用完，除非采取其他有效措施控制费用，否则真实的住院费用预计会上升。
Background. A key strategy used to contain hospital costs during the 1980s was to reduce the total number of admissions and average lengths of stay. We assessed the magnitude of the savings achieved, the effect of the reductions on the rate of increase in costs, and the prospects for future savings through reductions in the number of days patients spend in the hospital (inpatient days).Methods. Using data from the American Hospital Association and the Health Care Financing Administration, we calculated the savings in the total number of inpatient days as the deviation from the historical increase in the number of inpatient days per year. We then estimated the real increase in costs that would have been observed if the reduction in the number of inpatient days had not occurred; we defined this value as the "underlying" rate of increase in costs. Finally, we compared the rates of increase in hospital reimbursement for Medicare beneficiaries and patients not covered by Medicare (non-Medicare patients).Results. The total number of inpatient days per year decreased by 28 percent, in aggregate, between 1981 and 1988. The annual reduction was greatest in 1984 and 1985 and became progressively smaller in each subsequent year; by 1988 there was virtually no further reduction in the total number of inpatient days. The brief slowing of the increase in costs in the mid-1980s can be attributed entirely to the reduction in the number of inpatient days per year. The underlying rate of increase in costs was thus unaffected by efforts to contain spending. An increased number of outpatient visits partially offset the savings that resulted from the reduction in the number of inpatient days. This increase persisted even when the savings due to the lower number of inpatient days dwindled, and it virtually eliminated any dollar savings during the latter part of the 1980s. Between 1976 and 1982, Medicare spending on services provided by acute care hospitals rose by 9.2 percent per year in real terms, whereas non-Medicare expenditures rose by only 4.6 percent. This pattern has been reversed in recent years; in 1987-1988, Medicare spending rose by only 0.6 percent per year, whereas non-Medicare spending rose by 9 percent.Conclusions. Our findings suggest that the era of easy reductions in the number of inpatient days, with the associated attenuation of rising costs, is largely over. If further reductions in inpatient days are accompanied by an increase in the amount of ambulatory care similar to that during the past few years, the net savings will probably be negligible. Once the potential savings due to reductions in the number of inappropriate inpatient days has been exhausted, real hospital costs can be expected to rise, unless other effective measures to contain costs are implemented.