Luft Harold S
Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA 94301.
Health Serv Res. 2015 Dec;50 Suppl 2(Suppl 2):2187-215. doi: 10.1111/1475-6773.12423. Epub 2015 Nov 17.
Policy makers (both public and private) are seeking ways to improve the value delivered within our health care system, that is, using fewer resources to provide the same benefit to patients, or using equivalent resources to provide more benefit. One strategy is to alter the predominant fee-for-service (FFS) economic incentives in the current system. To inform such policy changes, this paper identifies areas in which little is known about the effects of specific incentives (FFS, salary, etc.) on the two components of value: resource use and quality. Specific suggestions are offered regarding research that would be informative for policy makers, focusing on fundamental "building block" studies rather than overall evaluations of complex interventions, such as accountable care organizations. This research would better identify critical aspects of the FFS model and salary-based payments that are particularly problematic, as well as situations in which FFS or salary may be less problematic. The research would also explore when alternatives, such as episode-based payment might be feasible, or simply be hypothetical solutions. The availability of electronic health record-based data in various delivery systems would allow many of these studies to be accomplished in 3-5 years with budgets manageable by public and private funding sources.
政策制定者(包括公共部门和私营部门)正在寻求方法来提高我们医疗保健系统所提供的价值,也就是说,用更少的资源为患者提供相同的益处,或者用等量的资源提供更多的益处。一种策略是改变当前系统中占主导地位的按服务收费(FFS)经济激励措施。为了为这类政策变化提供依据,本文确定了一些领域,在这些领域中,对于特定激励措施(如按服务收费、薪资等)对价值的两个组成部分——资源使用和质量——的影响,我们了解甚少。针对对政策制定者有参考价值的研究提出了具体建议,重点是基础性的“基石”研究,而非对诸如 accountable care organizations 等复杂干预措施的全面评估。这项研究将更好地识别按服务收费模式和基于薪资支付中特别成问题的关键方面,以及按服务收费或薪资问题较少的情况。该研究还将探讨诸如基于诊疗期间的支付等替代方案何时可能可行,或者仅仅是假设性的解决方案。各种医疗服务提供系统中基于电子健康记录的数据的可用性将使许多此类研究能够在3至5年内完成,且预算在公共和私营资金来源可承受范围内。