University of Zurich, Switzerland.
Health Aff (Millwood). 2011 Mar;30(3):510-8. doi: 10.1377/hlthaff.2010.0954.
Policy makers in several industrial countries are seeking to limit the rise in health care cost growth by supporting coordinated or integrated care programs, which differ from most prevailing forms of medical organization in how physicians are paid and how they work in groups. However, as long as fee-for-service payment systems remain an option, general practitioners will be reluctant to embrace coordinated care because it would give them less autonomy in how they practice. A study in Switzerland indicates that general practitioners will require a pay increase of up to 40 percent before they are willing to accept coordinated care, and a similar study found that Swiss consumers wanted a substantial reduction in premiums to accept it. These findings suggest that provisions of US health care reform designed to encourage the growth of coordinated care--such as accountable care organizations and medical homes--may face a challenging future.
一些工业国家的政策制定者正在寻求通过支持协调或整合护理计划来限制医疗保健成本的增长，这些计划与大多数流行的医疗组织形式在医生的薪酬和工作方式上有所不同。然而，只要按服务收费的支付系统仍然是一种选择，全科医生就不愿意接受协调护理，因为这会使他们在实践中丧失自主权。瑞士的一项研究表明，全科医生愿意接受协调护理之前，他们需要高达 40%的薪酬增长，而类似的研究发现，瑞士消费者希望大幅降低保费来接受协调护理。这些发现表明，美国医疗改革中旨在鼓励协调护理增长的条款——如问责制医疗组织和医疗之家——可能面临着充满挑战的未来。
