Center for Health Equity Research and Promotion, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Health Aff (Millwood). 2011 Apr;30(4):690-8. doi: 10.1377/hlthaff.2010.1277.
The payment approach known as "pay-for-performance" has been widely adopted with the aim of improving the quality of health care. Nonetheless, little is known about how to use the approach most effectively to improve care. We examined the effects in 260 hospitals of a pay-for-performance demonstration project carried out by the Centers for Medicare and Medicaid Services in partnership with Premier Inc., a nationwide hospital system. We compared these results to those of a control group of 780 hospitals not in the demonstration project. The performance of the hospitals in the project initially improved more than the performance of the control group: More than half of the pay-for-performance hospitals achieved high performance scores, compared to fewer than a third of the control hospitals. However, after five years, the two groups' scores were virtually identical. Improvements were largest among hospitals that were eligible for larger bonuses, were well financed, or operated in less competitive markets. These findings suggest that tailoring pay-for-performance programs to hospitals' specific situations could have the greatest effect on health care quality.
支付方式被称为“按绩效付费”，已被广泛采用，旨在提高医疗保健质量。然而，对于如何最有效地利用这种方法来改善医疗服务，人们知之甚少。我们研究了医疗保险和医疗补助服务中心与全国性医院系统 Premier Inc 合作开展的一项按绩效付费示范项目对 260 家医院的影响，并将这些结果与未参与示范项目的 780 家对照组医院的结果进行了比较。该项目中医院的表现最初比对照组的表现有所改善：与对照组中不到三分之一的医院相比，超过一半的按绩效付费医院获得了高绩效评分。然而，五年后，这两组的评分几乎相同。在有资格获得更大奖金、资金充足或在竞争不那么激烈的市场中运营的医院中，改善幅度最大。这些发现表明，根据医院的具体情况量身定制按绩效付费计划，可能对医疗质量产生最大影响。
