ๆญฏ1์์ฝ๋ณธ.PDF
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1 KOREA HEALTH INDUSTRY DEVELOPMENT INSTITUTE
2 : ( ) : ( ) ( ) ( ) ( ) ( ) ( ) ( )
3 / 1 / / / / / i
4 6 / / / ii
5 / / / / iii
6 4-6 ADRG ADRG (10 ) 60 ADRG (10 ) 61 ADRG (4 ) ADRG (4 ) ADRG (4 ) RDRG (10 ) RDRG (10 ) RDRG (10 ) RDRG (10 ) RDRG RDRG ADRG (10 ) ADRG (10 ) ADRG (10 ) ADRG (10 ) ADRG (10 ) ADRG (10 ) ADRG (10 ) ADRG (10 ) ADRG (10 ) ADRG,, (10 ) ADRG,, (10 ) 78 iv
7 4-37 (10 ) (10 ) (10 ) (10 ) (10 ) (10 ) ,, (10 ) ( ) 92 ( ) 93 ( ) v
8 vi
9 vii
10
11 , ,,
12 ,, ,,,., 1 ( - / - ),
13 ). ( ) ( ).. Moving Target, 2).,, (Networking). 1),, ) : 2002 ( ) wp/ seisaku/jigyou/jizen/ isei.html#09
14 % % ) 17 96, , 12, 18 ( : 14 ) ) 17 10
15 700, 300, 1, % 70% 60% ( ), 60% (` %, ` %, ` %). 2001,
16 (70% ) 52.2% 21.8%. 4., ,420, DRG(Dignosis Related Group) 12.7, ,.,,,, 60 70, ADRG ADRG 59 (Tonsilectomy &/or Adenoidectomy). 10 ADRG
17 RDRG, 6 RDRG, 3 RDRG. RDRG 26.4%, %. RDRG 20.7%, %,,,,,.,,,,..,. episode..
18 , %,,, (21.8%) % ,, 3.,.,,, 5.2
19 . (Medical Staff Organiazion : MSO) MSO (Physician fee) (Hospital fee) (Physician Office) (My Doctor) 4). (Hospitalist) (Key Success Factors),,,.. ( ) 4) 1 (Primary Care Physician, PCP),, 1
20 % 0.15%, 0.21%, 0.1% 10% 1.53%, 2.06%, 1.03%, 20% 3.06%, 4.12%, 2.06%. 40% 6.11%, 8.24%, 4.12% 5% 43, %, 1,345,901 10% 87, % 2,723, %, 4,319, ,050 (43 ), 1,422,450 (87 ), 2,256,300 (138 ),.,
21 7.,,, DRG,, ,, ( ) (,,, )
22 ( ) 7.2,,,,,,,
23
24 ( ), (, ), ( ), , 9, 6, 15 30
25 2.., 2.,
26 ). 2), (,, ),, 3),
27 4 4) 5). 6) 2003, ),,
28 ) 30
29 ,, - - -,, ) (,, ), :,,, - : : DRG Grouper, DRG,, 4),,.
30 , 1997, 2000, ),, Consensus Building Method
31 ,,,, 1) 2 3, ( ) ( ) ( ), ( ) ( ) ( ) ( 1),, 2001
32 2 9 ) ( ) (closed hospital system), (open hospital system).,, (attending physicians).
33 10.,,. ( ),.., (Trustee), (Managers), (Physician, Nurses)..,,. (Medical Staff Organization)...
34 2 11.,,.,, ( ). ( ).,., ( ).. (Hospitalist) ( 5 ) ( )
35 ),.....,.....,
36 , 3 3..,., ).,
37 14.,
38 2 15 3) ).,
39 16., (Doctor 's shopping),,,,...,,,.,
40 ( - / - ),
41 18, , , ,
42 ) 1 2 2). ( ) ( ).. Moving Target 70 80%.. 3). (Sustainable), 2),, )
43 20., 4).. - ( - ) 2).. (Clarity ) (Con sisten cy ).. (Desir ab ility ),,.,, 3 4) : 2002 ( ) wp/ seisaku/jigyou/jizen/ isei.html#09
44 ) - :, (, ) - :,,. - -, , -,
45 22 1 (Consistency). (Networking). ( ) 5).... 4)... 5), ( )
46 ) , (30%), 6 (20%), 15 (50%), 200 2, , , % %
47 , , 1 1 2) % % 8.4% , 2001
48 ( : %, ) ) ( ) 2) ( )
49 ( ) 22 8[7] 1(1) 13(3) , ( ) ( ) 1 1 ( ) ( ) , 1 [1 ] ( ) ( ) 9 7,
50 ( 3-2),, 3-4 (%) (%) ( ) 3-5 ( :, ) % 37.2%,,,,,,,
51 ( :, %) ( ) , , /4 0.8% / % 17.5%
52 3 29 ( :, %) (n=10) % % %
53 ( :, %) ( ) ,338, 2,817 4,155 96,
54 3 31 6, / ( : ) ~ , ,832 1, , , ( ) ( ) ,729,527, 770,766 (17 ) 2,500,293 7,267, 3,239, 10,505 1%
55 ( :, %) ~ 6 2,500, , , ,230 1,074,191 1,729, , , , , ,766 56, , , , , , , , , , , , , ,187 55,055 28,471 52,393 65,858 59, ,505 9,858 9,994 11,397 10,531 7,267 8,184 6,912 7,523 7,011 3,239 1,675 3,082 3,874 3,520 ( ) ( ) ,293, ( : ) ~ , ,433 1,516 1, % 48.2% 71.7% 28.3%,
56 % 57.6%, 3-11 ( :, ) 4,155 1,338 2,817 2,500,293 1,729, ,766 2, ,194 1,418,007 1,200, ,821 2, ,623 1,082, , , , ,737 45, , ,455 31, ,229 52,934 55,294 ( ) %. 2 86%(823 ) % 28
57 / ( : ) 4, , , , , , , , , , ( )
58 / ( : ) 4,155 1,338 2, , , , , , , , , , , , , , , , ( )
59 % 62.1%, 51.7% 3-14 ( : ) 2,500, ,729, , ,418, ,200, , ,082, , , , , , , , , , , , , , ,016, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ( )
60 3 37.,,,,,,,,,,,,,, ( : ) ~ 6 4, ,832 1, , , ( )
61 / ( :, %) 770, ,729, ,500, , , , , ,085, ,579, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ( )
62 ( :, %) 4,155 2,817 1,338 2,696 2, , ,577 1, ,800 1, ( )
63 40. 3., ( :, ) 1, ,304,258 1,107, ,222 2, ,868 1,196, , ,544 4,155 1,338 2,817 2,500,293 1,729, , , ,506 32, ,730 56,590 52, , ,737 45,339 ( ) ) , ,
64 ( :, %) ` ` ` ). ( %, %, %).,,, (,, ) 2001, , 2002.
65 ( : %) ` ` `02. 7 (, ) ( ) (,,, ) ( ) ( ),,,. (29.6%),
66 3 43 (24.1%), (24.1%) 3 (70% ) 52.2% 21.8%. / 65.2% 47.8%. 34.7% 56.5% 3-21 ( : %) ( ) ( ), /
67 ( ) 50%( ) 50%(, ) 30%(, ) 30% 40% 15 30%. ( )...,
68 3 45., 3)..,,,,
69 46.. (Hospital Fee) (Physician Fee)..., -,,,,, 1
70 % % , , 12, , 300, 1, % 70% 60% ( ),
71 48 60% ,, ( )..
72 ,....,,
73 ,,,
74 , ,
75 DRG(Dignosis Related Group). DRG DRG DRG ADRG(Adjusted DRG) RDRG(Refined DRG), ADRG DRG, RDRG ADRG 1.4 DRG DRG, ,,,,
76 4 53,,,,. 4-1 ( :,, ) * 2, ,121,589 1,229,705 9, ,358 1,115,217 ** 8, , , , ,116, ,189 8, ,364,032 1,518,843 9, ,273,425 1,511, ,427 8, , ,754 47, ,033,933 1,192,513 * **, 5.1.,,.
77 ( :,, ) 17, , ,071,792 4, ,955 3, ,109,297 5, ,839,304 3, ,529, ,427, ,454, ,520,927 1, ,271 4, ,222 1, ,780 1, , , ,020, , ,280, , ,956, ,. 4-3 ( :, ) * ,855 1,032, ,073,342 1,244,799 ** , , ,033,933 1,192,513 * **
78 4 55,,,, 4-4 ( : ),,,, % 14, % 2, % 17, % 3 0.4% % 0.0% % % 3, % 1, % 4, % % 2, % % 3, % % 5, % % 5, % % 2, % % 3, % 1 0.1% % 0.0% % 0.0% 1 0.0% 0.0% 1 0.0% 2 0.2% % 0.0% % 5 0.6% 1, % % 1, % % 1, % 2, % 4, % 4 0.5% 1, % % 1, % % 1, % % 1, % 0.0% % % % 3 0.4% % % % 0.0% 0.0% 5 0.1% 5 0.0% 0.0% % 0.0% % 0.0% % 3 0.0% % 0.0% % 0.0% % % 37, % 8, % 47, %
79 %.., %, 16.5%. 10, 20, 80., 55.0%, 34.7%. 4-5 ( :, ),,,, % 21, % 5, % 26, % % 16, % 3, % 20, % % 37, % 8, % 47, % % 2, % 2, % 4, % % 1, % % 1, % % 2, % % 3, % % 3, % 1, % 4, % % 5, % 1, % 7, % % 5, % % 6, % % 6, % 1, % 7, % % 6, % % 7, % % 3, % % 3, % % 37, % 8, % 47, % % 20, % 5, % 26, % % 13, % 3, % 16, % 9 1.1% % % % % 1, % % 1, % % 2, % % 2, % % 37, % 8, % 47, %
80 DRG 1) ADRG DRG. ADRG ADRG, ADRG 59 (Tonsilectomy &/ or Adenoidectomy). ADRG 214 (Back & Neck Procedures) 4-6 ADRG ( : ) ADRG ,
81 58 ADRG , , , , , ,
82 4 59 ADRG , , ,596 5,777 25,869
83 60 ADRG 10 ADRG. 11 ADRG ,490 1,914,. 4-7 ADRG (10 ) ( : ) ADRG 24(viral meningitis) (sinus) (tosillectomy) (myringotomy) (ottitis media) (pneumonia) (esophasitis) (cirrhosis) (back&neck proc) (medical back prob) (psychoses) ADRG 1., ADRG 202 1
84 ADRG ADRG (10 ) ( : ) * ** , , ,784 1,288, , , ,771 1,186, ,708 1,843,825 1,542,236 2,246, ,784 1,578,679 1,447,811 2,173, , , , , , , , , , , ,790 1,036, , , , , , , , , , , , , , , ,262 1,304, , , ,211 1,122, , , , , , , , , ,687 1,989,247 1,065,659 1,744, ,090 1,305, ,142 1,640, ,633,599 3,925,929 3,299,936 4,427,135 3,032,211 4,225, ,964 1,034, ,744 1,390, ,132 1,038, ,019 1,345, , , ,510 1,402,890 1,094,991 1,862, ,255 1,591,366 * **, 1 2) ADRG, ADRG ,. ADRG ADRG 214
85 ADRG (4 ) ( : ) ADRG 6(carpal tunnel syn) (back&neck proc) (major extrem proc) (soft tissue proc) (medical back prob) (breast proc for non-malig) (breast biopsy) ADRG ADRG (4 ) ( : ) ADRG 6(carpal tunnel syn) (back&neck proc) (major extrem proc) (soft tissue proc) (medical back prob) (breast proc for non-malig) (breast biopsy)
86 ADRG (4 ) ADRG ( : ) * ** 6 430, ,760 1,054,945 1,677, ,090 1,405, ,633,599 3,925,929 3,272,424 4,758,185 2,878,628 4,245, ,060 1,449,140 1,516,834 1,732,823 1,025,947 1,590, ,825 1,159,935 1,028,891 1,470, ,098 1,453, , , ,341 1,350, ,113 1,315, , , ,613 1,185, ,787 1,042, , , , , , ,429 * **, 1 3) RDRG ADRG,, ADRG. RDRG RDRG RDRG. RDRG 10 RDRG 9 RDRG 10, RDRG ( 17, 0 ). RDRG ( 17, 0 ) 2.3
87 RDRG (10 ) ( :, ) RDRG , , , 6 RDRG, 3 RDRG. 1 ADRG, ADRG, RDRG. RDRG 4-13 RDRG (10 ) ( : ) RDRG * ** ,275 2,005,925 1,530,094 2,191,408 1,466,990 2,171, , , , , , , , , , , , , , , , , , , , , , , , , ,193 1,111, , , , , , , , , , , ,921,306 2,938,637 3,108,588 3,951,333 2,636,536 3,548, ,592,405 6,640,983 3,843,404 6,053,150 4,176,293 6,314,409 * **, 1
88 ) ADRG ADRG, , % ADRG ADRG ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) , ,853 7,158,626 2,209,380 4,949, ,542, ,708 47,809,317 28,758,960 19,050, , ,026 38,576,811 34,451,690 4,125, , ,288 8,083,270 5,736,750 2,346, , ,750 10,077,829 8,001,490 2,076, , ,465 18,222,283 10,691,160 7,531, , ,115 18,325,063 10,327,270 7,997, ,065, ,687 10,656,592 5,966,870 4,689, ,299,936 2,633, ,497, ,511,950 29,985, , ,964 8,047,440 6,719,640 1,327, , ,158 8,175,095 6,951,580 1,223, ,629, ,326,740 85,302, , %
89 * ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) ,288, ,490 14,175,915 4,999,390 9,176, ,246,974 1,843,825 69,656,190 57,158,570 12,497, , ,359 52,946,400 42,598,350 10,348, ,036, ,755 13,477,425 9,369,820 4,107, , ,966 18,633,998 12,401,110 6,232, ,304, ,895 31,306,859 18,621,470 12,685, , ,692 35,662,862 19,783,610 15,879, ,744,312 1,989,247 17,443,121 19,892,470-2,449, ,427,135 3,925, ,221, ,666,800 22,554, ,390,644 1,034,775 13,906,438 10,347,750 3,558, ,402, ,766 14,028,905 9,867,660 4,161, ,459, ,707,000 98,752,199 *, 1, 70, % 4-16 ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) , ,685 6,421,650 1,767,540 4,654, ,269, ,433 39,355,927 23,387,420 15,968, , ,836 31,258,760 27,809,360 3,449, , ,035 6,466,668 4,589,450 1,877, , ,633 8,279,214 6,516,450 1,762, , ,680 15,288,071 9,256,310 6,031, , ,768 15,541,471 8,575,410 6,966, , ,565 9,421,658 5,065,650 4,356, ,670,316 2,146, ,164,239 96,609,370 23,554, , ,215 7,317,535 6,082,150 1,235, , ,556 6,999,665 5,965,560 1,034, ,514, ,624,670 70,890,188
90 , % * ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) ,077, ,254 11,847,481 3,841,799 8,005, ,789,068 1,455,729 55,461,098 45,127,592 10,333, , ,489 42,015,822 33,961,777 8,054, , ,003 10,428,400 7,306,038 3,122, , ,376 14,778,614 9,707,774 5,070, ,053, ,899 25,281,032 15,453,586 9,827, , ,543 28,800,996 15,819,104 12,981, ,465,697 1,600,101 14,656,965 16,001,010-1,344, ,549,667 3,162, ,735, ,291,282 17,443, ,182, ,511 11,829,016 8,775,113 3,053, ,153, ,897 11,534,999 8,178,973 3,356, ,369, ,464,048 79,905,395 *, 1 ADRG. 10., ADRG., RDRG 2) ADRG ADRG 4 7 ADRG
91 68, 78 42, % ADRG ADRG ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 6 4 1,054, ,308 4,219,780 1,721,230 2,498, ,272,424 2,633, ,259, ,511,950 28,747, ,516, ,060 10,617,840 3,745,420 6,872, ,028, ,825 4,115,564 1,547,300 2,568, , ,379 6,942,067 6,132, , , ,666 4,228,063 2,878,330 1,349, , ,958 1,604,836 1,515,830 89, ,987, ,052,470 42,934, , % 4-19 * ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 6 4 1,677, ,760 6,710,500 3,987,040 2,723, ,758,185 3,925, ,118, ,666,800 37,451, ,732,823 1,449,140 12,129,760 10,143,980 1,985, ,470,023 1,159,935 5,880,090 4,639,740 1,240, ,350, ,908 12,152,508 7,622,170 4,530, ,185, ,504 5,926,594 4,072,520 1,854, , ,893 2,516,176 2,115, , ,433, ,247,820 50,186,117 *, 1
92 4 69, 38, % 4-20 ( :, ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) , ,250 3,375,840 1,377,000 1,998, ,744,911 2,146, ,521,014 96,609,370 26,911, ,244, ,051 8,709,020 2,996,360 5,712, , ,465 3,494,977 1,237,860 2,257, , ,596 6,232,118 5,612, , , ,534 3,450,188 2,302,670 1,147, , ,173 1,320,256 1,212, , ,103, ,348,310 38,755, , % 4-21 * ( :, ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 6 4 1,329, ,340 5,319,436 3,069,361 2,250, ,907,269 3,162, ,827, ,291,282 33,535, ,397,615 1,141,393 9,783,302 7,989,749 1,793, ,208, ,665 4,832,205 3,678,661 1,153, ,140, ,306 10,260,822 6,608,752 3,652, , ,368 4,768,984 3,251,840 1,517, , ,346 1,922,175 1,669, , ,714, ,559,029 44,155,001 *, 1
93 70. RDRG 3) RDRG RDRG 10 9, , % RDRG RDRG , RDRG RDRG , , , , , , RDRG , , RDRG ADRG RDRG (10 ) ( :, ) RDRG (A) (B) (C) A B(D) A C(E) (D- E) ,530, ,275 36,722,247 22,902,610 13,819, , ,251 10,049,092 8,436,260 1,612, , ,754 26,822,381 24,108,950 2,713, , ,963 3,967,930 4,571, , , ,521 6,562,408 6,089, , , ,193 4,479,021 5,041, , , ,962 6,139,227 3,381,280 2,757, ,108,588 1,921, ,583,404 63,403,090 39,180, ,843,404 4,592,405 46,120,848 55,108,860-8,988, ,446, ,044,430 50,402, , %
94 RDRG * (10 ) ( :, ) RDRG (A) (B) (C) A B(D) A C(E) (D- E) ,191,408 2,005,925 52,593,791 48,142,200 4,451, , ,785 14,289,808 12,253,350 2,036, , ,710 35,386,875 28,381,950 7,004, , ,199 5,633,360 6,662,390-1,029, , ,505 13,213,454 8,749,600 4,463, ,553 1,111,826 8,965,525 11,118,260-2,152, , ,953 7,960,272 5,357,110 2,603, ,951,333 2,938, ,393,996 96,975,010 33,418, ,053,150 6,640,983 72,637,800 79,691,790-7,053, ,074, ,331,660 43,743,220 *, 1, 40, % 4-24 RDRG ( :, ) RDRG (A) (B) (C) A B(D) A C(E) (D- E) ,255, ,273 30,131,278 18,414,540 11,716, , ,005 8,115,048 6,749,080 1,365, , ,113 21,813,656 19,535,080 2,278, , ,774 3,174,380 3,657, , , ,481 5,328,854 4,987, , , ,704 3,775,789 4,347, , , ,374 5,139,299 2,705,100 2,434, ,488,517 1,580,158 82,121,074 52,145,210 29,975, ,169,785 3,705,347 38,037,416 44,464,160-6,426, ,636, ,004,640 40,632,155
95 , % 4-25 RDRG * ( :, ) RDRG (A) (B) (C) A B(D) A C(E) (D- E) ,738,796 1,575,001 41,731,094 37,800,025 3,931, , ,427 11,377,355 9,595,254 1,782, , ,705 27,973,506 22,801,723 5,171, , ,671 4,375,196 5,216, , , ,143 10,383,027 6,842,719 3,540, , ,802 7,193,874 8,968,019-1,774, , ,673 6,453,047 4,268,790 2,184, ,139,062 2,372, ,589,052 78,307,675 25,281, ,919,669 5,331,967 59,036,032 63,983,607-4,947, ,112, ,783,859 34,328,324 *, ADRG ADRG (ratio)
96 ADRG (10 ) ( : ) ADRG / , , , ,708 1,542,236 1,466, , , , , , , , , , , , , , , , ,687 1,065,659 1,062, ,633,599 3,299,936 3,032, , , , , , , , ADRG (ratio) (ratio). ADRG ADRG (10 ) ( : ) ADRG / 24 28, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,692 59,264 59,
97 ADRG (10 ) ADRG % 25.5% 25.2% % 32.1% 30.7% % 25.6% 18.0% % 30.0% 23.1% % 40.9% 40.4% % 37.7% 37.4% % 30.1% 30.0% % 29.8% 29.7% % 20.0% 15.5% % 20.9% 20.8% % 7.2% 7.3% * = /, (ratio) ADRG (ratio) (ratio). ADRG
98 ADRG (10 ) ( : ) ADRG / 24 83, , , , , , , ,928 86, ,798 79,567 65, , , , , , , , , , , , , , , , , , , , , , ADRG (10 ) ADRG % 42.2% 42.2% % 12.7% 12.6% % 17.5% 15.6% % 12.8% 12.0% % 29.9% 30.0% % 31.9% 32.0% % 31.6% 31.7% % 36.7% 36.7% % 12.3% 9.2% % 40.0% 40.2% % 70.1% 70.0% * = /
99 76 (ratio) (ratio) (ratio) 4-31 ADRG (10 ) ( : ) ADRG / 24 7,395 55,141 52, , ,793 95, ,767 26,771 23, ,314 54,915 38, ,606 37,921 36, ,274 47,435 46, ,538 35,519 34, ,418 74,771 74, ,492 97,605 64, ,053 79,420 79, ,335 52,930 53, ADRG (10 ) ADRG % 8.5% 8.4% % 6.7% 6.5% % 4.5% 4.2% % 8.8% 7.0% % 9.8% 9.6% % 6.2% 6.2% % 7.2% 7.1% % 7.0% 7.0% % 3.0% 2.1% % 9.9% 9.9% % 6.5% 6.5% * = /
100 4 77 ADRG (ratio) (ratio) (ratio) 4-33 ADRG (10 ) ( : ) ADRG / 24 40, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,253 14,478 15, ADRG (10 ) ADRG % 22.6% 22.5% % 29.7% 28.5% % 26.4% 18.4% % 25.6% 19.8% % 38.5% 38.3% % 37.8% 37.6% % 29.3% 29.3% % 27.8% 27.8% % 20.0% 15.7% % 16.6% 16.5% % 1.8% 1.8% * = /
101 78,,. (ratio) ADRG,, (10 ) ( : ) ADRG / 24 48, , , , , , , , , , , , ,207 62,814 62, , , , , , , , , , ,982,418 1,744,789 1,840, , , , ,304 40,242 40, ,, 4-36 ADRG,, (10 ) ADRG % 17.9% 18.0% % 31.6% 32.8% % 26.9% 34.8% % 28.5% 33.8% % 16.2% 16.4% % 18.7% 18.7% % 25.0% 24.9% % 22.9% 22.9% % 52.9% 60.7% % 15.4% 15.3% % 4.9% 4.9% * = /
102 4 79,,,,., ,,,,,,, (10 ) ( :, ) , , , , , , , , , , , , , , , , (ratio) 5 1,
103 (10 ) ( : ) / 456, , , , , , ,046,780 1,108,657 1,107, ,152,082 1,953,645 1,937, ,997,521 1,646,252 1,665, , , , , , , ,251 1,113,350 1,106, (ratio) (ratio) 4-39 (10 ) ( : ) / 119, , , ,131 32,835 33, , , , , , , , , , ,831 90,107 86, , , , , , , (ratio) (ratio)
104 (10 ) ( : ) / 160, , , , , , , , , , , , , , , , , , , , , , , , (ratio) (ratio) 4-41 (10 ) ( : ) / 19,705 68,473 68, ,894 26,339 26, ,518 50,066 49, , , , , , , ,437 18,116 17, ,683 63,199 57, ,576 68,425 67, (ratio) (ratio)
105 (10 ) ( : ) / 126, , , ,113 12,604 12, , , , , , , , , , , ,360 99, , , , , , , (ratio). 4-43,, (10 ) ( : ) / 103, , , ,950 26,819 26, , , , , , , ,354, , , ,281 66,109 64, , , , , , , ,,,,.
106 , 4-44 ( :, ) , , , , , , , (ratio) ( : ) / 799,068 1,056,688 1,048, ,209,341 1,177,331 1,177, ,533 1,104,119 1,098, , 4-46 ( : ) / 105, , , , , , , , ,
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194 17 1,. 1997,, , ,, ,,, 1998 C.T. Horngren, G. Foster,,, 1992 Alpers, A. Key legal principles for hospitalists. 2002, Dis Mon 48(4): Barnsteiner, J. H., C. Madigan, et al. Instituting a disruptive conduct policy for medical staff. AACN Clin Issues, (3): Berry, K. Hospital- physician relationships: What ' s working, what 's not working. Health Care Strategic Management, (3): Craig DE, Hartka L, Likosky WH, Caplan WM, Litsky P, Smithey J. Implementation of a hospitalist system in a large health maintenance organization: the Kaiser Permanente experience. Ann Intern Med. 1999;130: Freese RB. The Park Nicollet experience in establishing a hospitalist system. Ann Intern Med. 1999;130: Griffith J R, White K R., The Well- Managed Healthcare Organization, Fifth Edition. AUPHA Press Harris, C. Hicks, Lanis L. Kelly, Bruce J., Physician- hospital networking: Avoiding a shotgun wedding, Healthcare Management Review, (4), Henry LA. Will hospitalists assume family physicians' inpatient care roles? Family Practice Management. 1997;July- August: assn.org/ ama/pub/printcat/ 2512.html Kongstvedt P R., The Managed Health Care Handbook, Third Edition. An Aspen Publisher. 1996
195 172 Lindenauer PK, Pantilat SZ, Katz PP, Wachter RM. hospitalists and The practice of inpatient Medicine: results of A National survey. Ann Intern Med. in Press. Mintzberg, Henry, T oward Healthier Hospital, Health Care Management Review, 1997, 22(4), 9-18 Moore JD Jr. The inpatient ' s best friend. "Hospitalists" spedalize in managing care of the very ill. Mod Healthc. 1997;27: Nanci E. Noise, Stephen M. Shortell and Michael A. Morrisey, A Survey of Hospital Medical Staffs - Part 1 & 2, Hospital, 57, 1983 OECD Health Data 2000 Rakich J S, Longest Jr. B B, Darr K. Managing Health Services Organizations, Third Edition. Health Professions Press Robert WM. An introduction to the hospitalist model. Annals of Internal Medicine. 1999:130: Sal Fiscina, Marcia Mobilia Boumil, David J.Sharpe, Murdock Head, Medical Liability, West Group, 1991 Shi L, Singh D A. Delivering Health Care in America: A Systems Approach, Second Edition. An Aspen Publisher Starfield B, Simpson L. Primary care as part of US health services reform. JAMA. 1993;269: Starfield B. Primary Care: Concept, Evaluation, and Policy. New York: Oxford Univ Pr; Stephen J. Williams and Charles M.Ewell, Medical Staff Leadership : A National Panel Survey, Health Care Management Review, 1996, 21(2), Stephen M. Shortell & Arnold D. Kaluzny (Editor), Health Care Management: Organization Design & Behavior, Delmar Learning, 1999 U.S. Institute of Medicine, Division of Health Care Services, Committee on the Future of Primary Care. Defining Primary Care: An Interim Report. Washington, DC: National Academy Pr; 1994.
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