Department of Internal Medicine, Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI, 48109-0429, USA.
Health Serv Res. 2012 Feb;47(1 Pt 2):404-13. doi: 10.1111/j.1475-6773.2011.01358.x. Epub 2011 Dec 8.
When everyone is required to pay the same out-of-pocket amount for health care services regardless of clinical indication, there is evidence of underuse of high-value services and overuse of interventions of no or marginal clinical benefit. Unlike most current health plan designs, value-based insurance design (V-BID) acknowledges heterogeneity of clinical interventions and patient characteristics. It encourages the use of services with strong evidence of clinical benefit and likewise discourages the use of low-value services. Implementing this concept into the national policy debate required a strategy that included conceptual framework development, program implementation, rigorous evaluation, media outreach, and an advocacy plan. Upon completion of this strategy involving several colleagues from multiple disciplines, Congress included language specifically authorizing V-BID in the Patient Protection and Affordable Care Act. A wide-ranging approach, planned as early as possible, can lead to the successful translation of health services research to policy.
当每个人在医疗服务方面都需要支付相同的自付额，而不受临床指征的影响时，就会出现高价值服务使用不足和无临床获益或边际临床获益的干预措施使用过度的情况。与大多数现行的健康计划设计不同，基于价值的保险设计（Value-based Insurance Design，V-BID）承认临床干预措施和患者特征的异质性。它鼓励使用具有强有力临床获益证据的服务，同样也不鼓励使用低价值的服务。将这一概念纳入国家政策辩论需要制定一项策略，其中包括概念框架的制定、计划的实施、严格的评估、媒体宣传和宣传计划。在涉及来自多个学科的几位同事完成这一策略后，国会在《患者保护与平价医疗法案》（Patient Protection and Affordable Care Act）中特别授权使用基于价值的保险设计。尽早规划全面的方法可以成功地将卫生服务研究转化为政策。
