Health Research and Information Division, Economic and Social Research Institute, Whitaker Square, Sir John Rogerson’s Quay, Dublin 2, Ireland.
Health Econ Policy Law. 2012 Jan;7(1):73-101. doi: 10.1017/S1744133111000314.
Following the US experience, activity-based funding has become the most common mechanism for reimbursing hospitals in Europe. Focusing on five European countries (England, Finland, France, Germany and Ireland), this paper reviews the motivation for introducing activity-based funding, together with the empirical evidence available to assess the impact of implementation. Despite differences in the prevailing approaches to reimbursement, the five countries shared several common objectives, albeit with different emphasis, in moving to activity-based funding during the 1990s and 2000s. These include increasing efficiency, improving quality of care and enhancing transparency. There is substantial cross-country variation in how activity-based funding has been implemented and developed. In Finland and Ireland, for instance, activity-based funding is principally used to determine hospital budgets, whereas the models adopted in the other three countries are more similar to the US approach. Assessing the impact of activity-based funding is complicated by a shortage of rigorous empirical evaluations. What evidence is currently available, though, suggests that the introduction of activity-based funding has been associated with an increase in activity, a decline in length of stay and/or a reduction in the rate of growth in hospital expenditure in most of the countries under consideration.
继美国之后，基于活动的筹资已成为欧洲国家补偿医院的最常见机制。本文以五个欧洲国家（英国、芬兰、法国、德国和爱尔兰）为例，综述了引入基于活动的筹资的动机，以及评估实施效果的现有经验证据。尽管在补偿方法上存在差异，但在 20 世纪 90 年代和 21 世纪初转向基于活动的筹资时，这五个国家都有一些共同的目标，尽管重点不同。这些目标包括提高效率、改善医疗服务质量和提高透明度。在实施和发展基于活动的筹资方面，各国之间存在很大差异。例如，在芬兰和爱尔兰，基于活动的筹资主要用于确定医院预算，而其他三个国家采用的模式更类似于美国的方法。由于缺乏严格的实证评估，评估基于活动的筹资的影响变得复杂。不过，目前现有的证据表明，在大多数考虑中的国家，引入基于活动的筹资与活动增加、住院时间缩短和/或医院支出增长率下降有关。
