Rosenthal Meredith B, Landon Bruce E, Normand Sharon-Lise T, Frank Richard G, Epstein Arnold M
Department of Health Policy and Management, Harvard School of Public Health, Boston, USA.
N Engl J Med. 2006 Nov 2;355(18):1895-902. doi: 10.1056/NEJMsa063682.
Pay for performance has increasingly become the subject of intense interest and debate, both of which have been heightened as the Centers for Medicare and Medicaid Services moves closer to adopting this approach for Medicare. Although many claims have been made for the effectiveness of this approach, the extent of its national penetration remains unknown.
We surveyed a sample of 252 health maintenance organizations (HMOs) (response rate, 96%) drawn from 41 metropolitan areas across the nation about use of pay for performance. We determined the prevalence of pay-for-performance programs, detailed the features of such programs, and examined the adoption of pay for performance as a function of the characteristics of both the health plans and markets.
More than half the HMOs, representing more than 80% of persons enrolled, use pay for performance in their provider contracts. Of the 126 health plans with pay-for-performance programs, nearly 90% had programs for physicians and 38% had programs for hospitals. Use of pay for performance was statistically associated with geographic region, use of primary care providers (PCPs) as gatekeepers, use of capitation to pay PCPs, and whether the plans themselves received bonuses or penalties according to performance.
Pay for performance is now commonly used by HMOs, especially those that are situated to assign responsibility for a particular patient to a PCP or medical group. As the design of Medicare with pay for performance moves forward, it will be important to leverage the early experience of pay for performance in the commercial market.
绩效薪酬日益成为人们高度关注和激烈辩论的主题，随着医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）越来越接近将这种方法应用于医疗保险，这两者都被进一步激化。尽管人们对这种方法的有效性提出了许多主张，但其在全国的普及程度仍然未知。
我们对从全国41个大都市地区抽取的252家健康维护组织（HMO）进行了抽样调查（回复率为96%），询问其绩效薪酬的使用情况。我们确定了绩效薪酬计划的普及率，详细说明了此类计划的特点，并研究了绩效薪酬的采用情况与健康计划和市场特征之间的关系。
超过一半的HMO（代表超过80%的参保人员）在其与医疗服务提供者的合同中使用绩效薪酬。在126个设有绩效薪酬计划的健康计划中，近90%有针对医生的计划，38%有针对医院的计划。绩效薪酬的使用在统计学上与地理区域、将初级保健提供者（PCP）作为看门人、使用按人头付费方式支付PCP以及计划本身是否根据绩效获得奖金或处罚有关。
HMO现在普遍使用绩效薪酬，尤其是那些将特定患者的责任分配给PCP或医疗集团的HMO。随着带有绩效薪酬的医疗保险设计向前推进，利用商业市场中绩效薪酬的早期经验将很重要。
