Department of Accounting and Finance, Faculty of Economics and Business Administration, University of Zaragoza, Zaragoza, Spain.
Health Econ Policy Law. 2013 Jul;8(3):335-64. doi: 10.1017/S1744133112000345. Epub 2013 Jan 24.
In a context of cost containment and demands for better quality in public health care, payment systems are used as an instrument to promote efficiency improvements in service providers. Andalusia has adopted an original type of risk-adjusted capitation payment mechanism to reimburse public hospitals. This paper presents the main characteristics of the reimbursement mechanism of the Andalusian Health Service highlighting some differences with the mechanisms adopted in other parts of Europe. The paper also explores the evolution of the efficiency and quality of the hospitals after its implementation using the Malmquist index. Results indicate that hospitals have slightly improved their efficiency, particularly urban hospitals, and these improvements are not significantly related to a negative evolution of quality. However, it is not possible to assert to what extent, improvements are the consequence of the new payment system. The organisation of the Servicio Andaluz de Salud and the limited competition between hospitals reduce the effectiveness of the reform.
在控制成本和提高公共医疗保健质量的要求下，支付系统被用作促进服务提供者提高效率的工具。安达卢西亚采用了一种独特的风险调整总额预付支付机制来补偿公立医院。本文介绍了安达卢西亚卫生服务的报销机制的主要特点，突出了与欧洲其他地区采用的机制的一些差异。本文还使用 Malmquist 指数探讨了该机制实施后医院效率和质量的演变。结果表明，医院的效率略有提高，特别是城市医院，而且这些改进与质量的负面演变没有显著关系。然而，我们无法确定在多大程度上，这些改进是新支付系统的结果。安达卢西亚卫生局的组织和医院之间有限的竞争降低了改革的效果。
