Chernew Michael, Gibson Teresa B
Harvard Medical School, USA.
Med Care Res Rev. 2008 Dec;65(6):713-28. doi: 10.1177/1077558708319683. Epub 2008 Jun 16.
Physicians, health plans, and health systems are increasingly evaluated and rewarded based on Health Plan Effectiveness Data and Information Set (HEDIS) and HEDIS-like performance measures. Concurrently, employers and health plans continue to try to control expenditures by increasing out-of-pocket costs for patients. The authors use fixed-effect logit models to assess how rising copayment rates for physician office visits and prescription drugs affect performance on HEDIS measures. Findings suggest that the increase in copayment rates lowers performance scores, demonstrating the connection between financial aspects of plan design and quality performance, and highlighting the potential weakness of holding plans and providers responsible for performance when payers and benefit plan managers also influence performance. Yet the effects are not consistent across all domains and, in many cases, are relatively modest in magnitude. This may reflect the HEDIS definitions and suggests that more sensitive measures may capture the impact of benefit design changes on performance.
医生、健康计划和医疗系统越来越多地根据健康计划有效性数据与信息集（HEDIS）以及类似HEDIS的绩效指标进行评估和奖励。与此同时，雇主和健康计划继续试图通过增加患者自付费用来控制支出。作者使用固定效应logit模型来评估医生门诊和处方药共付率的上升如何影响HEDIS指标的表现。研究结果表明，共付率的提高会降低绩效得分，这表明了计划设计的财务方面与质量绩效之间的联系，并凸显了在支付方和福利计划管理者也影响绩效的情况下，要求计划和提供者对绩效负责的潜在弱点。然而，这些影响在所有领域并不一致，而且在许多情况下，影响程度相对较小。这可能反映了HEDIS的定义，并表明更敏感的指标可能会捕捉到福利设计变化对绩效的影响。
