Length of stay in the VA. Long-term care in short-term hospitals.
Length of stay in the VA. Long-term care in short-term hospitals.
复制标题
在 VA 的停留时间。
DOI：
10.1097/00005650-198703000-00008
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发表时间：
1987
期刊：
影响因子：
3
通讯作者：
Mosely2nd,RR
中科院分区：
文献类型：
--
作者：
Wolinsky,FD;Coe,RM;Mosely2nd,RR
一段时间以来，美国的医疗保健服务一直受到广泛的审查。在过去的十年中，讨论集中在医疗工业综合体、医疗保健的货币化、企业医疗的发展以及相关的成本控制等主题上。直到最近，退伍军人管理局（VA）的医疗保健系统，经营172个医疗中心（130万住院和1860万门诊），一直幸免于这种审查。[4]这种最低限度的监督的一个原因是退伍军人管理局系统自林肯政府成立以来一直享有强大的政治支持。[5]国会在审议蒙哥马利-哈默施泰特的提案时，似乎要改变退伍军人管理局迄今为止未受影响的立场，试图在1987财政年度的退伍军人管理局预算中节省3亿美元。具体考虑的是对家庭年收入超过25 000美元的退伍军人征收每年476美元的免赔额。鉴于退伍军人事务处制度的独特性质，特别是在大部分都会地区，使用该制度的人已经排起了长队，这种通过经济状况调查来控制费用的方法不大可能成功。5在VA医疗保健提供系统中控制成本的另一种方法是专注于最大限度地提高运营效率。最近发布的一份关于退伍军人事务部的总会计办公室（GAO）报告显示，近43%的医疗和手术日是可以避免的。在这一数字中，20%是由于管理不善，23%是由于无法获得成本较低的护理水平（即缺乏适当的纵向一体化）。尽管GAO的报告是基于从7家VA医院随机选择的350例病例，但其含义是
The delivery of health care in the United States has been under extensive scrutiny for some time. In the past decade, the discussion has focused on the medical industrial complex,'the monetarization of medical care, 2 the growth of corporate medicine, 3 and re-lated cost-containment topics. Until quite recently, the Veterans Administration (VA) health care system, which operates 172 medical centers (1.3 million hospital admissions and 18.6 million outpatient visits), has been spared such scrutiny. 4 One reason for this minimal oversight by others is the strong political support that the VA system has enjoyed since its inception in Lincoln's administration. 5 Congress, in its consideration of the Montgomery-Hammerschmidt proposal, appears about to change the VA's heretofore untouched position in an attempt to save $300 million in the fiscal year 1987 VA budget. Under specific consideration is the imposition of the $476 per year deductible for veterans whose annual family income exceeds $25,000. Given the unique nature of the VA system, especially the queues that already exist for access to the system in most metropolitan areas, such a means-test ap-proach to cost containment is not likely to be successful. 5An alternative approach to cost containment in the VA health care delivery system is to focus on maximizing operational effi-ciency. A recently released General Ac-counting Office (GAO) report on the VA indicates that nearly 43% of the medical and surgical days reviewed were medically avoidable. Of this figure, 20% are attributable to poor management practices and 23% to the unavailability of less costly levels of care (ie, the absence of appropriate vertical integration). 6 Although the GAO report was based on 350 randomly selected cases from only seven VA hospitals, the implication is