[근거중심의학] [펌] 포괄수가제에 대해 개구라치는 정부

[곰이오☞☜]

출처: http://www.docple.com/01_community/community_viw.aspx?key=605914&groupno=40&nPage=1

제목

XXX들...

글쓴이

푸도

No. 605914

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첨부파일		등록일	2012-06-11 오전 9:05:25

＇ㄱ＇으로 시작하는 XXX의 원 단어를 썼다가, 이성을 찾고서 X로 대체하였습니다.

얼마나 화가 났는지 짐작하시리라 믿습니다.

다름이 아니오라,

보건복지부/심평원/건보공단의 이름으로 만든 ＇포괄수가제, 오해와 진실＇이라는 책자에 아래와 같은 내용이 들어 있습니다.

영문 해석도 물론 틀렸지만 (고비용이 의료의 질 향상을 의미하는 것이 아니다 => 고비용이 항상 의료의 질 향상을 의미하는 것은 아니다),

그 내용이 궁금해서 찾아보았습니다.

원 자료는 아래의 자료이더군요.

항목들이 보이십니까?

바로 미국의 주(state)별 Medicare(65세 이상 노인과 장애인에게 제공되는 서비스) 의 소요비용과 의료의 질의 상관관계를 나타내는 그림입니다.

정부는 이 그래프에 임의로 선을 그어서 비용과 의료의 질이 역관계를 가지고 있는 것처럼 선전을 한 것입니다.

정말 @W#(*#@$()가 아닐 수 없습니다.

진실은 무엇일까요?

미국에서는 지역별 편차(Geographic Variation)에 대한 관심사가 클 수 밖에 없고, 그 해답은 아래 설명에 나와 있습니다.

Evidence on the Relationship Between Spending and Quality

The relationship between spending and quality is better understood for Medicare spending than for overall or

non-Medicare health care spending, and it could be different for Medicare and the rest of the health care sector.

18 Several studies have examined the relationship between average spending and the quality of care provided

to the Medicare population in different areas. The quality measures used are limited: Studies generally focus

on relatively easy-to-measure standards of “good medical practice,” some of which are noted below.

The evidence does not indicate that higher Medicare spending is associated with better care for Medicare beneficiaries.

In fact, it suggests the opposite: After adjusting for other factors, areas with higher Medicare spending

tend to score substantially worse on a composite indicator of the quality of care provided to Medicare beneficiaries. That finding is echoed in the work of the Dartmouth Atlas Project: Areas with higher end-of-life

expenditures in Medicare tend to perform worse in several dimensions of quality—particularly those that

involve low-cost interventions (Fisher and others 2003a).

Even stronger evidence of the lack of an association between spending and quality of care comes from a state level study of the way patient care changed as spending changed over time (Baicker and Chandra 2004a). The

researchers found that if spending per Medicare beneficiary increased by $1,000 in a state, there was an associated decrease in most measures of “good” medical practice, including, for example, the share of heart attack patients who were given aspirin (a 3.6 percentage point decrease) or offered advice about smoking cessation(6.8 percentage points) at discharge, the share of pneumonia patients who received antibiotics within 8 hours of arrival at the hospital (2.0 percentage points), and the share of diabetes patients whose blood sugar concentrations were eval‎uated (3.2 percentage points).

Other studies have focused on other dimensions of quality, including patient satisfaction, functional status, and

mortality rates. Fisher and others (2003a) identified regions (in this case HRRs) as high or low spending on

the basis of Medicare expenditures at the end of life and showed that high-spending areas had aggregate mortality rates and mortality rates from several chronic diseases that either were slightly higher than or the same as rates in low-spending regions.20 Higher spending also was found not to be associated either with increased patient satisfaction or with improvements in patient function and health status (Fisher and others 2003b). And according to one study, physicians in high-spending areas noted more difficulty in coordinating care, providing for continuity of care, and communicating with other physicians (Sirovich and others 2006).

Two other recent studies that have analyzed the relationship among spending, medical treatment patterns, and

health outcomes provide possible explanations for the lack of an association between higher spending and better health outcomes. Landrum and others (2008) showed that patients who had colorectal cancer and lived in high spending regions were more likely to receive chemotherapy than were similar patients in low-spending

regions. And that treatment was given, it is critical to note, both to patients for whom it generally is recommended

(those with stage III colon cancer) and to some for whom it is not and for whom it might in fact be harmful (those with stage I colon cancer, older patients, and those with multiple accompanying illnesses). The

implication is that patterns of higher-cost, higher intensity treatment could benefit some patients but

harm others.

The second study examined treatment for heart attack (Chandra and Staiger 2007). Among heart attack

patients, high-cost surgical intervention will be more appropriate in some cases, and low-cost medical management will be more appropriate in others. The researchers report that patients for whom the high-cost surgical treatment was more appropriate fared better if they lived in areas that practiced surgical procedures on more patients, which tend to be high-spending areas. But patients for whom low-cost medical management was more appropriate fared worse in high-intensity, high-spending areas.

Both studies suggest that the relationship between high cost, intensive treatment and health outcomes is complex and depends on the patient population and the disease being treated.

아무렇지도 않게 국민에게 거짓말을 하는 정부,

분노를 참기 어렵습니다.

용서하기 어렵습니다.

무식한 것인가요? 나쁜 것인가요? 이런 일은 참으면 안되겠지요?

그런데 매우 흥미로운 부분이 있습니다.

1. 메디케어 환자들에게 DRG를 시행하고 있습니다.

2. 주마다 1인당 진료비가 1,000불씩 상승할 때, Good Medical Practice의 지표들, 즉 심장마비 환자들에게 아스피린을 제공하거나, 금연교육을 제공하거나, 당뇨환자에게 혈당을 체크하거나 혹은 폐렴환자에게 조기에 항생제를 투여하는 등의 진료행위가 줄어들었다는 것을 보여주고 있다고 연구자들은 밝히고 있습니다. 무슨말인고 하니, 위에 ＇의료의 질＇을 평가하는 도구로 표준화하기가 쉬운 Good Medical Practice를 지표로 사용하였는데 진료비가 늘어날수록 이 Good Medical Practice의 지표들이 줄어든다는 뜻입니다. 아직도 무슨 얘기인지 잘 이해가 안가시죠?

위 조사는 메디케어 환자들을 대상으로 한 것이고, 메디케어는 현재 DRG를 하고 있습니다. 진료비와 진료의 질이 역상관관계가 나타나는 이유는, 바로 ＇포괄수가제＇를 하고 있기 때문인 것입니다. 즉 비용 때문에 제대로 된 진료서비스를 제공하지 못하는 ＇포괄수가제＇의 폐해를 여실히 보여주고 있는 그래프인 것입니다.

[잊혀진계절]

하... 진짜 ㄱㅅㄲ들 이게 다 MB때문이다. 무식한넘 의전만든 노오란 그분이나 포괄수가제 시행하는 현 쥐새끼나... ㅉㅉ