Sussex Jonathan, Farrar Shelley
Office of Health Economics, London, SW1A 2DY, UK.
Eur J Health Econ. 2009 May;10(2):197-206. doi: 10.1007/s10198-008-0119-0. Epub 2008 Aug 5.
Activity-based funding of hospital services has been introduced progressively since 2003 in the National Health Service (NHS) in England, under the name 'Payment by Results' (PbR). It represents a major change from previous funding arrangements based on annual "block" payments for large bundles of services. We interviewed senior local NHS managers about their experience and expectations of the impact of PbR. A high degree of 'NHS solidarity' was apparent, and competition between NHS hospitals was muted. PbR has been introduced against a background of numerous other efficiency incentives, and managers did not detect a further PbR-specific boost to efficiency. No impact on care quality, either positive or negative, is yet evident.
自2003年起，英国国家医疗服务体系（NHS）逐步引入基于活动的医院服务资金制度，称为“按结果付费”（PbR）。这与此前基于对大量服务进行年度“整体”支付的资金安排相比有了重大变化。我们采访了NHS当地的高级管理人员，了解他们对按结果付费的影响的经验和期望。“NHS团结”程度很高，NHS医院之间的竞争并不激烈。按结果付费是在众多其他效率激励措施的背景下推出的，管理人员并未发现它对效率有进一步的、特定于按结果付费的提升作用。目前还没有明显迹象表明它对护理质量有正面或负面的影响。
