MEDICARE REIMBURSEMENT AND THE QUALITY OF HOSPITAL CARE

本研究的目的是探讨 医疗保险报销政策和提供的护理质量之间的关系 医院的病人。 高质量结果的最佳预测因素是 提供适合已确定需求的临床护理， 病人 当正确的诊断和 提供治疗程序，给出体征和症状， 患者介绍。 该提案将执行一个辅助数据 对兰德公司正在进行的研究的分析， 以医院为基础的优质服务的定义和测量。 基本 设计策略是一个前后研究的病人护理跨越 1983年底，医疗保险实施了预期支付。 在 除了提供的过程和结果的临床指标外， 兰德研究，结构变量描述参与 医院将被添加到一个回归模型中， 质量. 这些结构变量包括当地市场和医院 特点，以及医疗保险计划的报销。 这项研究旨在确定质量的差异， 根据参与医院的结构特点解释。 具体目标是： 有助于提高医院护理质量的因素 - 识别和 测量质量的区域差异。 - 确定付款的效力 质量水平。 - 评估预期付款对 质量.

The objective of the proposed research is to examine the relationship between Medicare reimbursement policy and the quality of care provided to hospital patients. The best predictor of a high quality outcome is the provision of clinical care appropriate to the identified needs of the patient. Quality is maximized when proper diagnostic and therapeutic procedures are provided given the signs and symptoms the patient presents with. This proposal would perform a secondary data analysis upon research underway at the RAND Corporation directed at the definition and measurement of hospital based quality care. The basic design strategy is a before and after study of patient care straddling the implementation of prospective payment by Medicare in late 1983. In addition to the clinical measures of process and outcome provided by the RAND research, structural variables describing the participating hospitals will be added to a regression model attempting to predict quality. These structural variables include local market and hospital characteristics, as well as reimbursement by the Medicare program. This research is designed to identify the variance in quality which is explained by structural characteristics of the participating hospitals. The specific aims are to: - Identify market and hospital organizational factors which contribute to quality hospital care. - Identify and measure area differences in quality. - Establish the effect of payment level on quality. - Assess the impact of prospective payment on quality.