Prospective payment systems and hip fracture treatment costs.
Prospective payment systems and hip fracture treatment costs.
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未来的支付系统和髋部骨折治疗费用。
DOI：
10.3109/17453679709003967
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发表时间：
1997
期刊：
影响因子：
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通讯作者：
Olle Svensson
中科院分区：
文献类型：
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作者：
L. Strömberg;Gunnar Öhlén;Olle Svensson
我们研究了在斯德哥尔摩实施前瞻性支付系统之前和之后，在自己家中入院的1,060名和1,178名老年患者髋部骨折后的医疗保健消费和成本。总住院日数通过合并住院数据库和市政老年人住宿记录进行估计。通过使用一个详细的病人相关的会计系统和分离的手术成本和“酒店”成本，我们可以比较不同类型的康复成本。报销制度改变后，骨科住院时间几乎减半，从20天减少到12天。这是由于老人科病房的病人较早出院及出院人数增加，以致病床日数增加一倍（107%），以致总成本实际上增加12%。这一点从官方保健统计数据中并不明显，这些统计数据显示了更有利的成本发展，因为大部分老年保健的诊断相关登记不再包括在内。相比之下，在一家急性医院的康复计划，强调在术后阶段的连续性，减少了12%的治疗和康复的总成本。旨在减少急性护理费用的预期报销不一定会导致总体节省。
We studied the health care consumption and costs after a hip fracture in 1,060 and 1,178 elderly patients admitted from their own home before and after the implementation of a prospective payment system in Stockholm. The total number of bed-days was estimated by merging the inpatient database and the municipal records of living accommodations for the elderly. By using a detailed patient-related accounting system and separating cost for surgery and "hotel" cost, we could compare costs in different types of rehabilitation. After the change in reimbursement system, the orthopedic stay was almost halved from 20 to 12 days. This was achieved by earlier and increased discharge to geriatric wards, where bed-day consumption doubled (107%), so that the total cost actually increased by 12%. This is not readily apparent from the official heath care statistics, which depict a more favorable cost development, as diagnosis-related registration for a large part of the geriatric care is no longer included. In contrast, a rehabilitation program in one of the acute hospitals, emphasizing continuity in the postoperative phase, reduced the total cost for treatment and rehabilitation by 12%. A prospective reimbursement aiming at reducing the costs of acute care does not necessarily result in overall savings.