Averill Richard F, Goldfield Norbert I, Vertrees James C, McCullough Elizabeth C, Fuller Richard L, Eisenhandler Jon
3M Health Information Systems, Wallingford, Connecticut 06492, USA.
J Ambul Care Manage. 2010 Jan-Mar;33(1):2-23. doi: 10.1097/JAC.0b013e3181c9f437.
The healthcare reform goal of increasing eligibility and coverage cannot be realized without simultaneously achieving control over healthcare costs. The reform of existing payment systems can provide the financial incentive for providers to deliver care in a more coordinated and efficient manner with minimal changes to existing payer and provider infrastructure. Pay for performance, best practice pricing, price discounting, alignment of incentives, the medical home, payment by episodes, and provider performance reports are a set of payment reforms that can result in lower costs, better coordination of care, improved quality of care, and increased consumer involvement. These reforms can produce immediate Medicare annual savings of $10 billion and create the framework for future savings by establishing financial incentives for long-term provider behavior changes that can lead to lower costs.
如果不能同时实现对医疗成本的控制，那么扩大医保资格范围和覆盖人群这一医疗改革目标便无法达成。对现有支付系统进行改革，能够为医疗服务提供者提供经济激励，促使他们以更协调、高效的方式提供医疗服务，同时对现有的医保支付方和医疗服务提供方的基础设施改动最小。按绩效付费、最佳实践定价、价格折扣、激励措施调整、医疗之家、按诊疗流程付费以及医疗服务提供方绩效报告，这些支付改革措施能够降低成本、更好地协调医疗服务、提高医疗质量并增强消费者的参与度。这些改革能够立即为医疗保险每年节省100亿美元，并通过建立经济激励机制促使医疗服务提供方长期改变行为，从而带来更低的成本，为未来的成本节省创造框架。
