Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
Chest. 2013 Nov;144(5):1712-1716. doi: 10.1378/chest.12-2324.
When consumers are required to pay the same out-of-pocket amount for pulmonary services for which clinical benefits depend on patient characteristics, clinical indication, and provider choice, there is an enormous potential for both underutilization and overutilization. Unlike most current one-size-fits-all health plan designs, value-based insurance design (V-BID) explicitly acknowledges clinical heterogeneity across the continuum of care. By adding clinical nuance to benefit design, V-BID seeks to align consumer and provider incentives with value, encouraging the use of high-value services and discouraging the use of low-value interventions. This article describes the concept of V-BID; creates a framework for its development in pulmonary medicine; and outlines how this concept aligns with research, care delivery, and payment reform initiatives.
当消费者需要为肺脏服务支付相同的自付额，而临床获益取决于患者特征、临床指征和提供者选择时，就存在极大的过度使用和使用不足的潜在风险。与大多数当前一刀切的健康计划设计不同，基于价值的保险设计（V-BID）明确承认整个护理连续体中的临床异质性。通过在福利设计中增加临床细微差别，V-BID 试图使消费者和提供者的激励与价值保持一致，鼓励使用高价值服务，并抑制使用低价值干预措施。本文描述了 V-BID 的概念；为其在肺脏医学中的发展创建了一个框架；并概述了这一概念如何与研究、护理提供和支付改革举措保持一致。
