Evaluating health care delivery reform initiatives in the face of "cost disease".
Evaluating health care delivery reform initiatives in the face of "cost disease".
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评估面对“成本病”的医疗保健提供改革举措。
DOI：
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发表时间：
2015
影响因子：
2.5
通讯作者：
K. Finison
中科院分区：
文献类型：
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作者：
Steven Thompson;R. Kohli;Craig Jones;N. Lovejoy;Katharine McGraves;K. Finison
作者分析了2007年至2011年佛蒙特州所有支付者索赔数据库中所有商业保险和医疗补助覆盖的个人的历史索赔数据，以确定人均住院费用，每次出院费用和住院日费用。作者进一步评估了分配给心理健康、产妇护理、外科服务和医疗服务的所有医疗保健支出的比例。虽然在研究期间住院服务的利用率下降，但每次出院的费用和每次住院日的费用以补偿的方式增加。虽然医疗补助人群对住院服务的利用率下降了8%，但每次出院的费用增加了84%。在商业保险中，每1000名成员的出院率在研究期间基本不变，每次出院的住院费用相对温和地增加了32%。在研究期间，心理健康、产科护理、外科服务和医疗服务的相对利用率没有变化。住院服务费用的大幅增加使外科服务总开支的比例从2007年的21%增加到2011年的33%。作者的结论是，尽管越来越多的医疗保健提供者被评估他们控制医疗保健成本的能力，同时实现更好的结果，但有许多成本驱动因素是他们无法控制的。评估以患者为中心的医疗之家等举措的努力应侧重于利用趋势和结果，而不是成本，或者至少反映医生和其他提供者无法影响的成本驱动因素。
The authors analyzed historical claims data from 2007 to 2011 from the Vermont All-Payer Claims database for all individuals covered by commercial insurance and Medicaid to determine per capita inpatient expenditures, cost per discharge, and cost per inpatient day. The authors further evaluated the proportion of all health care expenditure allocated to mental health, maternity care, surgical services, and medical services. Although utilization of inpatient services declined during the study period, cost per discharge and cost per inpatient day increased in a compensatory manner. Although the utilization of inpatient services by the Medicaid population decreased by 8%, cost per discharge increased by 84%. Among the commercially insured, discharges per 1000 members were essentially unchanged during the study period and inpatient cost per discharge increased by a relatively modest 32%. The relative utilization of mental health, maternity care, surgical services, and medical services was unchanged during the study period. The significant increase in the cost of inpatient services increased the proportion of total expenditure on surgical services from 21% in 2007 to 33% in 2011. The authors conclude that although health care providers are increasingly being assessed on their ability to control health care costs while achieving better outcomes, there are many cost drivers that are outside of their control. Efforts to assess initiatives, such as patient-centered medical homes, should be focused on utilization trends and outcomes rather than cost or, at a minimum, reflect cost drivers that physicians and other providers cannot influence.