Jegers Marc, Kesteloot Katrien, De Graeve Diana, Gilles Willem
Free University of Brussels (VUB), Micro Economics of the Profit and Non Profit Sectors, Pleinlaan 2, Belgium.
Health Policy. 2002 Jun;60(3):255-73. doi: 10.1016/s0168-8510(01)00216-0.
A typology to classify provider payment systems from an incentive point of view is developed. We analyse the way, how these systems can influence provider behaviour and, a fortiori, contribute to attain the general objectives of health care, i.e. quality of care, efficiency and accessibility. The first dimension of the typology indicates whether there is a link between the provider's income and his activity. In variable systems, the provider has an ability to influence his earnings, contrary to fixed systems. The second dimension indicates whether the provider's payments are related to his actual costs or not. In retrospective systems, the provider's own costs are the basis for reimbursement ex post whereas in prospective systems payments are determined ex ante without any link to the real costs of the individual provider. These different characteristics are likely to influence provider behaviour in different ways. Furthermore the most frequently used criteria to determine the provider's income are discussed: per service, per diem, per case, per patient and per period. Also a distinction is made between incentives at the level of the individual provider (micro-level) and the sponsor (macro-level). Finally, the potential interactions when several payment systems are used simultaneously are discussed. This typology is useful to classify and compare different types of payment systems as prevailing in different countries, and provides a useful framework for future research of health care payment systems.
本文构建了一种从激励角度对医疗服务提供者支付系统进行分类的类型学。我们分析了这些系统影响提供者行为的方式，进而有助于实现医疗保健的总体目标，即医疗质量、效率和可及性。该类型学的第一个维度表明提供者的收入与他的活动之间是否存在联系。与固定系统不同，在可变系统中，提供者有能力影响其收入。第二个维度表明提供者的支付是否与其实际成本相关。在追溯系统中，提供者自身的成本是事后报销的基础，而在前瞻系统中，支付是事前确定的，与单个提供者的实际成本没有任何联系。这些不同的特征可能会以不同的方式影响提供者的行为。此外，还讨论了确定提供者收入最常用的标准：按服务、按日、按病例、按患者和按时期。同时，还区分了个体提供者层面（微观层面）和资助者层面（宏观层面）的激励措施。最后，讨论了同时使用多种支付系统时的潜在相互作用。这种类型学有助于对不同国家普遍存在的不同类型的支付系统进行分类和比较，并为未来医疗保健支付系统的研究提供了一个有用的框架。
