Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA.
Health Aff (Millwood). 2009 Mar-Apr;28(2):w262-71. doi: 10.1377/hlthaff.28.2.w262. Epub 2009 Jan 27.
New strategies to control U.S. health spending growth are urgently needed. Although provider payment cuts are likely, cutting fee-for-service (FFS) payments will hurt quality and access. A more sensible approach would be to restructure the delivery system into organized networks of providers delivering reliable, evidence-based care. But restructuring will not occur without payment policy reform. Four policy options are commonly cited: recalibrating FFS, instituting pay-for-performance, creating episode-based payments, and adopting global payments. We argue that episode payments are the most immediately viable approach, and we recommend that payment reforms precede any payment reductions so that new delivery models can gain traction.
需要新的策略来控制美国医疗支出的增长。尽管可能会削减医疗服务提供商的支付费用，但削减按服务项目付费（FFS）将会损害服务质量和可及性。更明智的方法是将交付系统重组为提供可靠、基于证据的护理的有组织的提供者网络。但是，如果不进行支付政策改革，就不可能进行重组。通常会提到四种政策选择：重新校准按服务项目付费、实施基于绩效的支付、创建基于病例的支付和采用全球支付。我们认为基于病例的支付是最可行的方法，我们建议在进行任何支付削减之前进行支付改革，以便新的交付模式能够获得动力。
