Healthcare tariffs for specialist inpatient neurorehabilitation services: rationale and development of a UK casemix and costing methodology
Healthcare tariffs for specialist inpatient neurorehabilitation services: rationale and development of a UK casemix and costing methodology
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DOI：
10.1177/0269215511417467
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发表时间：
2012-03-01
影响因子：
3
通讯作者：
Dredge, Robert
中科院分区：
文献类型：
--
作者：
Turner-Stokes, Lynne;Sutch, Stephen;Dredge, Robert
目的：描述的理由和发展的casemix模型和成本计算方法的关税发展专科神经康复服务在英国。理由发展一种新的方法：复杂的需求患者承担更高的治疗成本。公平支付应按提供治疗的成本比例加权，并应允许随时间的变化Casemix模型和波段加权：病例复杂性由康复复杂性量表（RCS）衡量。根据RCS总分，案例被分为五个复杂度等级。恢复工作费用的主要决定因素是工作人员的时间。总工作人员小时/周（估计从诺思威克公园护理和治疗依赖量表）进行分析，在每个复杂性带，通过平行评级的横截面分析。计算成本的方法：总单位治疗成本是从提供服务的医院的预算和会计报表的回顾性分析中得出的。平均床日成本（总单位成本/占用床日）大致分为可变和非可变部分。在加权成本计算模式中，将组别加权系数应用于病床日成本的可变部分，以得出一个组别成本，从而得出一组成本乘数。从一个单位的初步数据，以说明这种加权成本计算模式将如何适用于推导出一个多层次的分段付款模式，根据序列的复杂性评级，允许随着时间的推移而变化。
Objective: To describe the rationale and development of a casemix model and costing methodology for tariff development for specialist neurorehabilitation services in the UK.Rationale for development of a new methodology: Patients with complex needs incur higher treatment costs. Fair payment should be weighted in proportion to costs of providing treatment, and should allow for variation over timeCasemix model and band-weighting: Case complexity is measured by the Rehabilitation Complexity Scale (RCS). Cases are divided into five bands of complexity, based on the total RCS score. The principal determinant of costs in rehabilitation is staff time. Total staff hours/week (estimated from the Northwick Park Nursing and Therapy Dependency Scales) are analysed within each complexity band, through cross-sectional analysis of parallel ratings. A band-weighting' factor is derived from the relative proportions of staff time within each of the five bands.Costing methodology: Total unit treatment costs are obtained from retrospective analysis of provider hospitals' budget and accounting statements. Mean bed-day costs (total unit cost/occupied bed days) are divided broadly into variable' and non-variable' components. In the weighted costing model, the band-weighting factor is applied to the variable portion of the bed-day cost to derive a banded cost, and thence a set of cost-multipliers. Preliminary data from one unit are presented to illustrate how this weighted costing model will be applied to derive a multilevel banded payment model, based on serial complexity ratings, to allow for change over time.