Goldfield Norbert I, Fuller Richard L, Averill Richard F
3M Health Information Systems, Wallingford, Connecticut 06492, USA.
Am J Med Qual. 2009 Nov-Dec;24(6):480-8. doi: 10.1177/1062860609341195. Epub 2009 Jul 20.
Policy reform is increasingly focused on the interrelated goals of improving care quality and increasing efficiency through provider coordination. Proposals must address 2 central issues: How to apportion stakeholder accountability and how to measure increased value (returns for resources spent). This article argues that incentives can be created for increasing coordination by specifying accountability for the 4 basic types of health care encounter defined in this article. Payment design can be used to identify units of service that are sufficiently narrow to give a transparent understanding of the type of care rendered but with the capacity for aggregation to describe the process as a whole. Transparency is defined as the use of categorical or rules-based models such as Diagnosis Related Groups. Payment systems can use a building block approach for each of the 4 types of health care encounter so as to encourage improved coordination of health care services.
政策改革越来越注重通过医疗服务提供者之间的协调来实现提高医疗质量和提升效率这两个相互关联的目标。改革提议必须解决两个核心问题：如何分配利益相关者的责任，以及如何衡量增加的价值（资源投入的回报）。本文认为，通过明确本文所定义的四种基本医疗服务类型的责任，可以激发促进协调的激励措施。支付设计可用于确定足够细化的服务单元，以便清晰了解所提供的医疗服务类型，同时具备汇总能力以描述整个过程。透明度被定义为使用分类或基于规则的模型，如诊断相关分组。支付系统可以针对四种医疗服务类型中的每一种采用积木式方法，以鼓励改善医疗服务的协调。
