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通过比较美国、澳大利亚和荷兰卫生系统中的病例组合管理模式,阐明了为什么某种病例组合模式在面临高编码风险方面要高于其他国家。该研究确定了不同市场、控制和病例组合特征决定的病例组合补偿制度在高编码风险方面存在的缺陷。比较美国,澳大利亚和荷兰系统可以得出以下结论:基于纳入营利性医院以及使用第二代诊断标准进行DRG分类的美国病例组合系统在高编码方面比澳大利亚更为开放。荷兰模式的优势在于有详细的分类方案,使用具有医学意义的分类标准。但是,与美国和澳大利亚的系统相比较显得更为复杂。文章对研究者以及政策制定者提出建议,在改进以及重组病例组合补偿制度时应当认真考虑相关的市场背景、控制以及病例组合的特征,以减少高编码风险。
By comparing case management practices in the health system in the United States, Australia and the Netherlands, it is elucidated why some combination patterns of cases are superior to others in the face of high coding risk. The study identifies flaws in high-risk coding of case portfolio compensation systems that are determined by different market, control and case portfolio characteristics. A comparison of the United States, Australia and the Netherlands system leads to the conclusion that the US case-combination system based on DRG classification for inclusion in for-profit hospitals and using second-generation diagnostic criteria is more open than Australia in high-coding. The advantage of the Dutch model is the detailed classification scheme, which uses the medical classification criteria. However, it is more complicated than that of the United States and Australia. The article suggests to researchers and policymakers that the relevant market context, controls, and combination of case characteristics should be carefully considered in improving and reorganizing the portfolio compensation system to reduce the risk of high coding.