London School of Economics and Political Science, UK.
Health Aff (Millwood). 2013 Apr;32(4):704-12. doi: 10.1377/hlthaff.2012.0964.
This article reviews efforts in the United States and several other member countries of the Organization for Economic Cooperation and Development to encourage patients, through cost sharing, to use goods such as medications, services, and providers that offer better value than other options--an approach known as value-based cost sharing. Among the countries we reviewed, we found that value-based approaches were most commonly applied to drug cost sharing. A few countries, including the United States, employed financial incentives, such as lower copayments, to encourage use of preferred providers or preventive services. Evidence suggests that these efforts can increase patients' use of high-value services--although they may also be associated with high administrative costs and could exacerbate health inequalities among various groups. With careful design, implementation, and evaluation, value-based cost sharing can be an important tool for aligning patient and provider incentives to pursue high-value care.
本文回顾了美国和经济合作与发展组织（OECD）的其他几个成员国所作的努力，这些国家通过成本共担，鼓励患者使用药品、服务和提供方等，这些产品和服务比其他选择更具价值，这种方法被称为基于价值的成本分担。在我们所审查的国家中，我们发现基于价值的方法最常用于药物成本分担。一些国家，包括美国在内，采用了财务激励措施，如降低共付额，以鼓励使用首选供应商或预防服务。有证据表明，这些努力可以增加患者对高价值服务的使用——尽管它们也可能与高昂的行政成本有关，并可能加剧不同群体之间的健康不平等。通过精心设计、实施和评估，基于价值的成本分担可以成为一种重要工具，用于调整患者和提供者的激励措施，以追求高价值的医疗服务。
