Bozic Kevin J, Smith Amanda R, Mauerhan David R
Department of Orthopaedic Surgery and Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California 94143-0728, USA.
J Arthroplasty. 2007 Sep;22(6 Suppl 2):8-12. doi: 10.1016/j.arth.2007.04.015. Epub 2007 Jul 26.
The United States health care system currently faces many challenges, including rising costs and variable quality. Health care purchasers and payers are demanding increased transparency and accountability for their health care dollars. Pay-for-performance (P4P) initiatives, which seek to link provider reimbursement to measures of quality and efficiency, have been introduced by both private and government payers. Despite their appeal over current provider reimbursement systems, which reward volume and intensity of services rather than quality and efficiency, P4P programs face numerous challenges in their implementation, including difficulty defining and measuring quality, high costs associated with collecting and analyzing performance data, problems with risk adjustment, lack of additional funding to reward quality, unintended consequences of provider gaming and patient deselection, and impact on low-tier, low-quality providers. Future efforts should involve collaboration among providers, payers, and policy makers to ensure that P4P programs are implemented safely and effectively.
美国医疗保健系统目前面临诸多挑战，包括成本不断上升和质量参差不齐。医疗保健购买者和支付者要求提高医疗保健费用的透明度和问责制。按绩效付费（P4P）计划试图将提供者的报销与质量和效率指标挂钩，已由私营和政府支付者推出。尽管P4P计划比当前奖励服务数量和强度而非质量和效率的提供者报销系统更具吸引力，但P4P计划在实施过程中面临诸多挑战，包括难以定义和衡量质量、收集和分析绩效数据的高成本、风险调整问题、缺乏奖励质量的额外资金、提供者博弈和患者被淘汰的意外后果，以及对低级别、低质量提供者的影响。未来的努力应包括提供者、支付者和政策制定者之间的合作，以确保P4P计划安全有效地实施。
