Goodman Robert M
Medical Director, Blue Care Network of Michigan, Southfield, MI 48076, USA.
Health Serv Manage Res. 2012 Nov;25(4):173-89. doi: 10.1177/0951484812474244.
To assess whether health plan implementation of specialist profile reports not associated with any health plan administered reward or consequence that measured physician cost efficiency relative to peers, and shared with specialists and primary care referral sources only, were associated with changes in specialist behaviour.
DATA SOURCE/STUDY SETTING: Blue Care Network of Michigan is a non-profit statewide Health Maintenance Organization and wholly owned subsidiary of Blue Cross Blue Shield of Michigan. This study used administrative data from 2002 to 2006 and included only providers and adult (ages 18-65) commercial membership located in Southeastern Michigan.
A difference-in-difference study design of before and after specialist cost efficiency reporting on six specialties to both specialists and primary care referral sources, but not health plan members, to determine whether specialists who performed worse than peers changed the level of utilization of their own physician services without any direct health plan reward or consequence.
Substantive changes were noted for interventional cardiology (-32.3%, P ≤ 0.01), orthopaedics (-13.3%, P ≤ 0.01) and otolaryngology (-15.9%, P ≤ 0.02). Less established, yet negative changes were noted for ophthalmology (-11.9%, P ≤ 0.01), gastroenterology (-3.2%, P = 0.23) and urology (-3.1%, P = 0.52).
Simple and transparent reports on specialist cost efficiency distributed to referral sources and specialists using a more laissez-faire style reporting only health plan programme can engage providers and be associated with reductions in utilization. Possible mechanisms include explicit pressure from referral sources or self-motivated change by specialists.
评估健康计划实施的专科医生概况报告（该报告不与任何健康计划管理的奖励或后果相关联，而是衡量医生相对于同行的成本效率，并且仅与专科医生和初级保健转诊来源共享）是否与专科医生行为的变化相关。
数据来源/研究背景：密歇根蓝十字蓝盾公司旗下的非营利性全州健康维护组织——密歇根蓝护网络。本研究使用了2002年至2006年的管理数据，仅纳入了位于密歇根东南部的提供者和18至65岁的商业成年会员。
一项差异研究设计，在向专科医生和初级保健转诊来源（而非健康计划成员）报告六个专科的专科医生成本效率前后进行对比，以确定表现比同行差的专科医生在没有任何直接健康计划奖励或后果的情况下，是否改变了其自身医生服务的使用水平。
介入心脏病学（-32.3%，P≤0.01）、骨科（-13.3%，P≤0.01）和耳鼻喉科（-15.9%，P≤0.02）出现了实质性变化。眼科（-11.9%，P≤0.01）、胃肠病学（-3.2%，P = 0.23）和泌尿外科（-3.1%，P = 0.52）的变化不太明显且呈负面。
以更为自由放任的方式仅向转诊来源和专科医生分发关于专科医生成本效率的简单透明报告（仅作为健康计划项目）能够促使医疗服务提供者参与其中，并与使用量的减少相关。可能的机制包括来自转诊来源的明确压力或专科医生的自我激励改变。
