Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA.
Health Aff (Millwood). 2012 Sep;31(9):2051-8. doi: 10.1377/hlthaff.2012.0368.
Since 1973 Medicare has provided health insurance coverage to all people who have been diagnosed with end-stage renal disease, or kidney failure. In this article we trace the history of payment policies in Medicare's dialysis program from 1973 to 2011, while also providing some insight into the rationale for changes made over time. Initially, Medicare adopted a fee-for-service payment policy for dialysis care, using the same reimbursement standards employed in the broader Medicare program. However, driven by rapid spending growth in this population, the dialysis program has implemented innovative payment reforms, such as prospective bundled payments and pay-for-performance incentives. It is uncertain whether these strategies can stem the increase in the total cost of dialysis to Medicare, or whether they can do so without adversely affecting the quality of care. Future research on the intended and unintended consequences of payment reform will be critical.
自 1973 年以来，医疗保险为所有被诊断患有终末期肾病（肾衰竭）的人提供医疗保险。在本文中，我们追溯了 1973 年至 2011 年医疗保险透析计划中支付政策的历史，同时也对随着时间的推移进行的改革的基本原理提供了一些见解。最初，医疗保险对透析护理采用了按服务收费的支付政策，使用了与更广泛的医疗保险计划相同的报销标准。然而，由于该人群的支出快速增长，透析计划实施了创新的支付改革，如前瞻性捆绑支付和按绩效付费激励措施。这些策略是否能够阻止透析给医疗保险带来的总成本的增加，或者它们是否能够在不影响护理质量的情况下做到这一点，尚不确定。未来对支付改革的预期和意外后果的研究至关重要。
