Christianson Jon B, Knutson David J, Mazze Roger S
Division of Health Services Research and Policy, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA.
J Gen Intern Med. 2006 Feb;21 Suppl 2(Suppl 2):S9-S13. doi: 10.1111/j.1525-1497.2006.00356.x.
Recent research underscores the gaps that exist between evidence-based medical practices and the care that many patients actually receive. Recognizing this, large purchasers are experimenting with new reimbursement arrangements called pay-for-performance (P4P) that tie a portion of payments for physician services to measures of quality. Agency theory, from the discipline of economics, provides a perspective on the challenges P4P is likely to encounter. The focus of most P4P initiatives on medical group performance raises additional questions about its potential effectiveness as a catalyst for change.
近期研究凸显了循证医学实践与许多患者实际接受的治疗之间存在的差距。认识到这一点后，大型医疗服务购买方正在试验一种名为“按绩效付费”（P4P）的新型报销安排，该安排将医师服务部分费用与质量指标挂钩。经济学领域的代理理论为P4P可能遇到的挑战提供了一个视角。大多数P4P计划关注医疗集团绩效，这引发了关于其作为变革催化剂的潜在有效性的更多问题。
