Bryan Stirling, Donaldson Cam
Director, Centre for Clinical Epidemiology & Evaluation, Vancouver CoastalHealth Research Institute, Professor, School of Population & Public Health, University of British Columbia, Vancouver, BC.
Yunus Chair in Social Business & Health, Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK.
Healthc Pap. 2016;15(3):25-30.
Since its introduction to the USA, the Triple Aim is now being adopted in the healthcare systems of other advanced economies. Verma and Bhatia (2016) (V&B) argue that provincial governments in Canada now need to step up to the plate and lead on the implementation of a Triple Aim reform program here. Their proposals are wide ranging and ambitious, looking for governments to act as the "integrators" within the healthcare system, and lead the reforms. Our view is that, as a vision and set of goals for the healthcare system, the Triple Aim is all well and good, but as a pathway for system reform, as articulated by V&B, it misses the mark in at least three important respects. First, the emphasis on improvement driven by performance measurement and pay-for-performance is troubling and flies in the face of emerging evidence. Second, we know that scarcity can be recognized and managed, even in politically complex systems, and so we urge the Triple Aim proponents to embrace more fully notions of resource stewardship. Third, if we want to take seriously "population health" goals, we need to think very differently and consider broader health determinants; Triple Aim innovation targeted at healthcare systems will not deliver the goals.
自“三重目标”被引入美国以来，其他发达经济体的医疗体系也开始采用这一理念。维尔马和巴蒂亚（2016年）（V&B）认为，加拿大省级政府现在需要行动起来，带头在本国实施“三重目标”改革计划。他们的提议范围广泛且雄心勃勃，期望政府在医疗体系中充当“整合者”，引领改革。我们的观点是，作为医疗体系的一种愿景和一系列目标，“三重目标”固然不错，但就像V&B所阐述的那样，作为一种系统改革路径，它至少在三个重要方面未达目标。其一，对由绩效评估和按绩效付费推动的改进的强调令人担忧，且与新出现的证据相悖。其二，我们知道，即使在政治复杂的系统中，资源稀缺问题也能被认识和管理，因此我们敦促“三重目标”的支持者更全面地接受资源管理理念。其三，如果我们想认真对待“人群健康”目标，就需要以截然不同的方式思考，并考虑更广泛的健康决定因素；针对医疗体系的“三重目标”创新无法实现这些目标。
