Montgomery Kathleen, Schneller Eugene S
University of California, Riverside, CA, USA.
Milbank Q. 2007 Jun;85(2):307-35. doi: 10.1111/j.1468-0009.2007.00489.x.
This article analyzes hospitals' strategies to shape physicians' behavior and counter suppliers' power in purchasing physician preference items. Two models of standardization are limitations on the range of manufacturers or products (the "formulary" model) and price ceilings for particular item categories (the "payment-cap" model), both requiring processes to define product equivalencies often with inadequate product comparison data. The formulary model is more difficult to implement because of physicians' resistance to top-down dictates. The payment-cap model is more feasible because it preserves physicians' choice while also restraining manufacturers' power. Hospitals may influence physicians' involvement through a process of orchestration that includes committing to improve clinical facilities, scheduling, and training and fostering a culture of mutual trust and respect.
本文分析了医院塑造医生行为以及在购买医生偏好项目时对抗供应商势力的策略。两种标准化模式分别是对制造商或产品范围的限制（“处方集”模式）以及对特定项目类别的价格上限（“支付上限”模式），这两种模式都需要定义产品等效性的流程，而产品比较数据往往不足。由于医生抵制自上而下的指令，“处方集”模式更难实施。“支付上限”模式更可行，因为它在保留医生选择权的同时也限制了制造商的势力。医院可以通过精心安排的流程来影响医生的参与，这一流程包括致力于改善临床设施、日程安排和培训，并营造相互信任和尊重的文化。
