Ryan Andrew M, Tompkins Christopher P, Markovitz Adam A, Burstin Helen R
1 University of Michigan School of Public Health, Ann Arbor, MI, USA.
2 Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA.
Med Care Res Rev. 2017 Aug;74(4):452-485. doi: 10.1177/1077558716650089. Epub 2016 May 23.
Policy makers and stakeholders have reached a consensus that both quality and spending or resource use indicators should be jointly measured and prioritized to meet the objectives of our health system. However, the relative merits of alternative approaches that combine quality and spending indicators are not well understood. We conducted a literature review to identify different approaches that combine indicators of quality and spending measures to profile provider efficiency in the context of specific applications in health care. Our investigation identified seven alternative models that are either in use or have been proposed to evaluate provider efficiency. We then used publicly available data to profile hospitals using these approaches. Profiles of hospital efficiency using alternative models yielded wide variation in performance, underscoring the importance of model selection. By identifying the current efficiency models and evaluating their trade-offs within specific programmatic contexts, our analysis informs stakeholder and policy maker decisions about how to link quality and spending indicators when measuring efficiency in health care.
政策制定者和利益相关者已达成共识，即质量指标以及支出或资源使用指标都应共同衡量并确定优先次序，以实现我们卫生系统的目标。然而，人们对结合质量和支出指标的替代方法的相对优点了解并不充分。我们进行了一项文献综述，以确定在医疗保健的特定应用背景下，将质量指标和支出措施相结合以描述提供者效率的不同方法。我们的调查确定了七种正在使用或已被提议用于评估提供者效率的替代模型。然后，我们使用公开可用的数据，运用这些方法来描述医院的情况。使用替代模型得出的医院效率概况在表现上差异很大，这突出了模型选择的重要性。通过识别当前的效率模型并评估它们在特定规划背景下的权衡，我们的分析为利益相关者和政策制定者在衡量医疗保健效率时如何将质量和支出指标联系起来的决策提供了参考。
