Matthews Lynda R, Hanley Francine, Lewis Virginia, Howe Caroline
Faculty of Health Sciences, Ageing, Work and Health Research Unit, The University of Sydney , New South Wales , Australia .
Disabil Rehabil. 2015;37(6):548-52. doi: 10.3109/09638288.2014.933897. Epub 2014 Jun 30.
With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature).
A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion.
Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions.
Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries.
Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.
随着工伤事故的社会和经济成本不断增加，能够带来高质量康复效果的高效支付模式愈发受到关注。本文基于学术文献以及非商业公开的研究资料（灰色文献），对这一问题进行探讨。
通过对支付模式、工伤赔偿和可赔偿伤害的综述，确定了相关的同行评审文献和灰色文献，为我们的讨论提供参考。
按服务收费和基于绩效的支付模式在健康与康复文献中占据主导地位，每种模式在为消费者实现高质量结果方面都既有优势也有挑战。在可赔偿的工伤环境中，似乎正朝着基于绩效的支付方式发展，因为人们认为这种方式能促进高效服务，并支持康复实践的创新。然而，文献中似乎缺少基于工作场所的康复提供者和专业人员在各种支付模式下工作时所面临的挑战，比如员工留用和医患关系质量等问题，这可能导致政策决策出现失误。
需要从客户/消费者、资助者和服务提供者的角度，获取与不同支付模式相关的收益和成本的有力证据，以为可赔偿工伤的康复最佳实践提供参考。
现有但有限的证据表明，为利益相关者认可的职业康复结果提供经济激励的支付模式，在工伤赔偿环境中往往能提高服务效果，不过几乎没有关于服务质量或客户满意度的证据。在一个根据利益相关者认可的结果确定支付的系统中工作，对于工伤赔偿环境中的康复从业者来说，可能会因为有更多临床自主权和创新实践而更满意。研究人员需要与赔偿和康复部门以及政府密切合作，从客户/消费者、资助者、服务提供者和康复专业人员的角度，确立支付模式收益和成本的有力证据。
