Sun Xi, Feng Zhanchun, Zhang Ping, Shen Xingliang, Wei Li, Tian Miaomiao
Medicine and Health Management School, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Health Bureau of Jiulongpo, Chongqing, China.
PLoS One. 2014 Feb 28;9(2):e89793. doi: 10.1371/journal.pone.0089793. eCollection 2014.
Pay-for-performance for patients is a cost-effective means of improving health behaviours. This study examined the association between the pay time for performance for patients and CHS use by chronic patients.
A cross-sectional study was undertaken to estimate distribution characteristics of CHS use in 2011 and collect data of socio-demographic characteristics (sex, age, education level, occupation, disposable personal income in 2011, distance between home and community health agency), chronic disease number, and time of pay-for-performance for patients. Participants were 889 rural adults with hypertension or type II diabetes aged 35 and above. Standardized CHS use means chronic patients use CHS at least once per quarter.
Patients who received incentives prior to services had 2.724 times greater odds of using standardized CHS than those who received incentives after services (95%CI, 1.986-3.736, P<0.001). For all subgroups (socio-demographic characteristics and chronic disease number), patients who received incentives prior to services were more likely to use standardized CHS than those receiving incentives after services.
Pay time for performance for patients was associated with CHS use by chronic patients. Patients receiving incentive prior to services were more likely to use standardized CHS. And pay time should not be ignored when the policy on pay-for-performance for patients is designed.
患者绩效薪酬是改善健康行为的一种具有成本效益的手段。本研究调查了患者绩效薪酬支付时间与慢性病患者社区卫生服务(CHS)利用之间的关联。
采用横断面研究来估计2011年社区卫生服务利用的分布特征,并收集社会人口学特征(性别、年龄、教育水平、职业、2011年个人可支配收入、家庭与社区卫生机构之间的距离)、慢性病数量以及患者绩效薪酬支付时间的数据。研究对象为889名年龄在35岁及以上的患有高血压或II型糖尿病的农村成年人。标准化的社区卫生服务利用是指慢性病患者每季度至少使用一次社区卫生服务。
在接受服务前获得激励的患者使用标准化社区卫生服务的几率是在接受服务后获得激励的患者的2.724倍(95%置信区间,1.986 - 3.736,P < 0.001)。对于所有亚组(社会人口学特征和慢性病数量),在接受服务前获得激励的患者比在接受服务后获得激励的患者更有可能使用标准化社区卫生服务。
患者绩效薪酬支付时间与慢性病患者社区卫生服务利用有关。在接受服务前获得激励的患者更有可能使用标准化社区卫生服务。在设计患者绩效薪酬政策时,支付时间不容忽视。