Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02114, USA.
J Gen Intern Med. 2009 Jul;24(7):854-9. doi: 10.1007/s11606-009-0947-3. Epub 2009 Mar 18.
Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain.
The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation.
We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients.
We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.
按绩效付费正在普及，但它对主要利益相关者的影响仍不确定。
内科学会系统地评估了基于绩效的医师薪酬所引发的伦理问题。
我们的结论是，目前的安排基于基本可接受的伦理原则，但对医疗质量的理解并不完整。此外，在没有安全性和有效性证据的情况下实施这些安排在伦理上是不稳定的，因为这对利益相关者，特别是弱势患者，存在潜在风险。
我们提出了四项主要策略，以从有风险的按绩效付费系统过渡到基于伦理的按绩效付费和高质量护理。这些策略包括在现行的按绩效付费系统中实施保障措施，就提高医疗质量的主要利益相关者的义务达成共识，制定有效和全面的医疗质量衡量标准，以及在创建奖励真正质量的下一代薪酬系统时采取谨慎的评估方法。
