Young Gary J
Center for Health Policy and Healthcare Research, D'Amore-McKim School of Business, Northeastern University, Boston, MA 02115, USA.
Qual Manag Health Care. 2013 Jul-Sep;22(3):187-98. doi: 10.1097/QMH.0b013e31829a6af3.
Pay for performance (P4P) has become a leading initiative for improving the quality of care in numerous countries around the world, most notably the United States and United Kingdom. However, the scientific evidence regarding the effectiveness of P4P for improving quality is quite thin. Applying a social capital perspective to the US experience with P4P, this article offers a conceptual analysis of the relationship between payers and providers relative to the prospect for improving the effectiveness of P4P as applied to quality of care. From this perspective, a key barrier to improving the effectiveness of P4P has been that payers and providers have not worked cooperatively in the design and implementation of these financial incentive programs. However, recent developments in the US health care system, namely, the formation of quality improvement collaboratives and global payment arrangements, are helping to redefine relationships between payers and providers that support innovative payment arrangements. These relationships are being redefined in ways that are in accordance with social capital concepts such as trust, commitment, and shared purpose. As such, the US experience offers lessons for improving the effectiveness of P4P in any context in which better cooperation between payers and providers is needed.
按绩效付费（P4P）已成为世界上许多国家提高医疗质量的一项主要举措，最显著的是美国和英国。然而，关于P4P提高质量有效性的科学证据相当薄弱。本文将社会资本视角应用于美国的P4P经验，对支付方与医疗服务提供者之间的关系进行了概念分析，涉及提高P4P应用于医疗质量有效性的前景。从这个角度来看，提高P4P有效性的一个关键障碍是，支付方和医疗服务提供者在这些经济激励计划的设计和实施过程中并未展开合作。然而，美国医疗体系最近的发展，即质量改进协作组织的形成和全球支付安排，正有助于重新定义支付方与医疗服务提供者之间的关系，以支持创新性支付安排。这些关系正以符合信任、承诺和共同目标等社会资本概念的方式被重新定义。因此，美国的经验为在任何需要支付方与医疗服务提供者更好合作的背景下提高P4P有效性提供了借鉴。
