Chapin R, Silloway G
University of Kansas, School of Social Welfare, Lawrence 66045.
J Appl Gerontol. 1992 Jun;11(2):131-45. doi: 10.1177/073346489201100201.
The federal Omnibus Budget Reconciliation Act of 1987 specifies that a state may establish a program to reward--through public recognition, incentive payments, or both--nursing facilities that provide the highest quality care to residents entitled to Medicaid. As state policymakers, providers, and advocates consider development of systems for rewarding quality in nursing homes, including incentive payments based on resident outcomes, theoretical and practical dilemmas must be addressed. The article examines the impetus for combining incentives with outcome measures and the conceptual dilemmas that outcome-based payments pose. Issues basic to successful implementation of incentive payments to nursing homes based on quality of care outcomes are also delineated.
1987年的联邦《综合预算协调法案》规定，州政府可以设立一项计划，通过公开表彰、奖励性支付或两者兼而有之的方式，奖励那些为有权享受医疗补助的居民提供最高质量护理的护理机构。随着州政策制定者、提供者和倡导者考虑开发养老院质量奖励系统，包括基于居民护理结果的奖励性支付，必须解决理论和实际困境。本文探讨了将激励措施与结果指标相结合的动力，以及基于结果的支付所带来的概念性困境。同时还阐述了基于护理质量结果向养老院成功实施奖励性支付的基本问题。
