This study analyzed the early effects of the Medicare Prospective Payment System (PPS) on the likelihood of hospital's discharging Medicare beneficiaries to skilled nursing facilities (SNFs), intermediate care facilities (ICFs), and home health agencies. It also examined length of stay before transfer. Discharge abstract data on patients in five DRG groups were studied. Data were obtained from 501 hospitals for the third quarters of 1980, 1983, 1984, and 1985. Multinomial logit and ordinary least squares regression techniques were employed. After controlling for hospital and patient characteristics, including severity of illness, it was found that the probability of transfer increased substantially in virtually all DRGs and discharge destinations studied. This was particularly true for patients with stroke, pneumonia, and major joint and hip procedure. The analysis reveals that PPS increased the rate of discharges to subacute facilities. This effect was stronger for transfer to SNFs than to ICFs and home health agencies. Further, the impact of PPS on transfers was greater in 1985 than in 1984. Lengths of stay before transfer tended to decline in almost all DRGs and destinations examined. However, the effects of PPS on lengths of stay of transferred patients were not statistically significant at conventional levels. The results suggest that payment experiments with broader forms of bundled services are in order, as are experiments with hospital acute-subacute swing beds.

译文

这项研究分析了医疗保险预期支付系统 (PPS) 对医院将医疗保险受益人送往熟练护理机构 (snf),中级护理机构 (icf) 和家庭保健机构的可能性的早期影响。它还检查了转移前的停留时间。出院摘要研究了五个DRG组患者的数据。数据来自1980年、1983、1984和1985第三季度的501家医院。采用多项式logit和普通最小二乘回归技术。在控制了医院和患者的特征 (包括疾病的严重程度) 之后,发现在几乎所有研究的drg和出院目的地中,转移的可能性都大大增加了。对于中风,肺炎以及主要关节和髋关节手术的患者尤其如此。分析表明,PPS增加了亚急性设施的排放率。这种效果对于转移到snf比转移到icf和家庭保健机构更强。此外,PPS对转移的影响1985年大于1984年。在几乎所有检查的drg和目的地中,转移前的停留时间都趋于减少。然而,在常规水平下,PPS对转移患者住院时间的影响在统计学上并不显着。结果表明,使用更广泛形式的捆绑服务进行支付实验,以及使用医院急性亚急性秋千床进行的实验也是如此。

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