Center for Studying Health System Change, Washington, DC, USA.
Health Aff (Millwood). 2012 Sep;31(9):1977-83. doi: 10.1377/hlthaff.2012.0350.
Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.
许多卫生政策分析师设想，目前正在开发的提供者支付改革将取代传统的按服务收费支付系统。这些改革包括按病例支付的捆绑支付和人头支付的一些要素，如总额支付或责任制医疗组织。但即使这些方法取得成功并得到广泛采用，许多医生提供服务的核心支付方式仍可能是按服务收费。因此，解决医疗保险医师费用表中当前的不足之处至关重要，因为这将影响医生的激励措施，并将继续在确定支付改革下的支付金额方面发挥重要作用。本文回顾了当前支付系统的发展和应用情况，并强调了需要仔细审查和修改的领域，以确保更广泛的支付改革取得成功。
