Wennberg John E, Fisher Elliott S, Skinner Jonathan S
Center for Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire, USA.
Health Aff (Millwood). 2002 Jul-Dec;Suppl Web Exclusives:W96-114. doi: 10.1377/hlthaff.w2.96.
Medicare spending varies more than twofold among regions, and the variations persist even after differences in health are corrected for. Higher levels of Medicare spending are due largely to increased use of "supply-sensitive" services--physician visits, specialist consultations, and hospitalizations, particularly for those with chronic illnesses or in their last six months of life. Also, higher spending does not result in more effective care, elevated rates of elective surgery, or better health outcomes. To improve the quality and efficiency of care, we propose a new approach to Medicare reform based on the principles of shared decision making and the promotion of centers of medical excellence. We suggest that our proposal be tested in a major demonstration project
医疗保险支出在各地区之间的差异超过两倍，即使在对健康差异进行校正之后，这种差异仍然存在。医疗保险支出水平较高主要是由于“供应敏感型”服务的使用增加，即看医生、专科会诊和住院治疗，特别是针对慢性病患者或生命最后六个月的患者。此外，较高的支出并没有带来更有效的治疗、更高的择期手术率或更好的健康结果。为了提高医疗质量和效率，我们基于共同决策原则和促进医疗卓越中心的理念，提出了一种医疗保险改革的新方法。我们建议在一个大型示范项目中对我们的提议进行测试。
