Gillett J, Hutchison B, Birch S
Department of Sociology and Anthropology, University of Windsor, Ontario, Canada.
Int J Health Serv. 2001;31(3):583-603. doi: 10.2190/2FEN-AQKK-LCEV-7KU5.
Alternative approaches to the funding, organization, and delivery of primary care have been the subject of ongoing discussion and debate in many industrialized nations for many years. One common recommendation has been to use capitation, as opposed to fee-for-service, as the payment method for physicians. In this study the authors use data from interviews with physicians and Ministry of Health officials to trace the evolution of Ontario's Health Service Organization (HSO) program, the only program of capitation-funded physician care in Canada. The program has developed in three phases: formation in the early 1970s, expansion in the late 1970s and throughout the 1980s, and restructuring in the 1990s. The analysis focuses on the perceptions and actions of policymakers and physicians who became involved with the program at different points in its evolution, and identifies how they perceived and responded to the financial incentives that were introduced to promote the program. This case study allows an examination of the shifting objectives, communications, perceptions, and responses of policymakers and stakeholders in changing contexts over a period of more than 20 years. The long history of the HSO program provides the opportunity to examine the factors that can cause financial incentives to go awry. The authors suggest how this case study offers lessons for financial incentive policymaking.
多年来，在许多工业化国家，初级医疗保健的资金筹集、组织和提供的替代方法一直是持续讨论和辩论的主题。一个常见的建议是使用按人头付费，而不是按服务收费，作为医生的支付方式。在本研究中，作者利用对医生和卫生部官员的访谈数据，追溯了安大略省医疗服务组织（HSO）项目的演变，该项目是加拿大唯一由按人头付费资助的医生护理项目。该项目分三个阶段发展：20世纪70年代初形成，70年代末至整个80年代扩张，90年代进行重组。分析重点关注在项目演变的不同阶段参与该项目的政策制定者和医生的看法和行动，并确定他们如何看待和应对为推动该项目而引入的财务激励措施。这个案例研究允许考察政策制定者和利益相关者在20多年的时间里，在不断变化的背景下不断变化的目标、沟通、看法和反应。HSO项目的悠久历史提供了一个机会，来考察可能导致财务激励措施出错的因素。作者提出了这个案例研究如何为财务激励政策制定提供经验教训。
