Silversmith Janet
Minnesota Medical Association, MN, USA.
Minn Med. 2011 Feb;94(2):45-8.
Among the leading strategies to reform health care is the development and implementation of new payment models. The goal is to change the way physicians, hospitals, and other care providers are paid in order to emphasize higher quality at lower costs--in other words, to improve value. In an effort to build on its health care reform activities that began in 2005, the Minnesota Medical Association convened a work group in 2010 to develop recommendations on how payment reform can best be advanced. Among the work group's output was a comparative review of five payment models with respect to how they can support a value-driven health care system. This article summarizes the pros and cons of the five models--fee for service, pay for coordination, pay for performance, episode or bundled payment, and comprehensive care or total cost of care payment. It also offers the work group's recommendations for how these models might be applied in a reformed health care system.
医疗保健改革的主要策略之一是开发和实施新的支付模式。目标是改变医生、医院和其他医疗服务提供者的付费方式，以强调以更低成本实现更高质量——换句话说，提高价值。为了在2005年开始的医疗保健改革活动基础上再接再厉，明尼苏达医学协会于2010年召集了一个工作组，就如何最好地推进支付改革制定建议。该工作组的成果之一是对五种支付模式进行了比较审查，内容涉及它们如何支持以价值为导向的医疗保健系统。本文总结了这五种模式——按服务收费、按协调付费、按绩效付费、按病种或捆绑付费以及综合护理或护理总成本付费——的优缺点。它还提供了工作组关于这些模式如何应用于改革后的医疗保健系统的建议。
