Heterogeneous hospital response to a per diem prospective payment system-异构...

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英文文献：Heterogeneous hospital response to a per diem prospective payment system-异构医院对每日预期支付系统的反应
英文文献作者：Galina Besstremyannaya
英文文献摘要：
The paper demonstrates the adverse effects of degressive rates, dependent on the percentiles of length of stay, in a prospective payment system with per diem payments. Using the dynamic panel data estimates with a recent nationwide administrative database for major diagnostic categories in 697 Japanese hospitals in July 2007- March 2012, the paper shows that average length of stay significantly increases (decreases) for hospitals in percentiles 0-25 (51-100) of the pre-reform length of stay. The decline of the average length of stay is larger for hospitals in higher percentiles of the length of stay. Hospitals in percentiles 51-100 significantly raise planned early readmission rate. As a remedy to the problem, the paper discusses the applicability of the “best practice” rate-setting.

本文论证了递减率的负面影响，取决于住院时间的百分比，在一个前瞻性支付系统，按日支付。通过对2007年7月至2012年3月697家日本医院主要诊断类别的全国管理数据库进行动态面板数据估计，本文显示，医院的平均住院时间显著增加(减少)百分比为改革前住院时间的0-25(51-100)。住院时间百分比越高的医院，平均住院时间的下降幅度越大。百分比为51-100的医院显著提高了计划早期再入院率。作为对这一问题的补救，本文讨论了利率制定的“最佳实践”的适用性。

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