Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Prev Chronic Dis. 2010 Sep;7(5):A98. Epub 2010 Aug 15.
The appeal of pay-for-performance in health care derives from the conceptual view that paying doctors and hospitals more to deliver better care will encourage them to deliver better care. What lessons can be learned from the successes and failures of pay-for-performance in health care settings that apply to pay-for-performance in population health? We argue that pay-for-performance requires conditions that are not easily met in population health settings. Pay-for-performance has focused on narrow clinical problems whose success depends on identifiable actors with the motivation and resources to change clinical processes or outcomes. In contrast, population health has broad goals, many antecedents, and no single, identifiable fiduciary (a person who holds assets in trust for a beneficiary). Nevertheless, with careful attention, conditions for successful pay-for-performance in population health might be met.
支付绩效在医疗保健中的吸引力源自这样一种概念性观点，即向医生和医院支付更多费用以提供更好的医疗服务将鼓励他们提供更好的医疗服务。在医疗保健环境中，从支付绩效的成功和失败中可以吸取哪些适用于人群健康的支付绩效的经验教训？我们认为，支付绩效需要满足的条件在人群健康环境中不容易满足。支付绩效主要关注那些狭隘的临床问题，其成功取决于具有改变临床流程或结果的动机和资源的可识别行为者。相比之下，人群健康有广泛的目标、许多前提，而且没有单一、可识别的受托人（代表受益人持有资产的人）。然而，如果仔细关注，人群健康中成功支付绩效的条件可能会得到满足。
