Rachel H. DeMeester was assistant deputy director of the Robert Wood Johnson Foundation (RWJF) Finding Answers: Solving Disparities through Payment and Delivery System Reform Program Office at the University of Chicago, in Illinois.
Lucy J. Xu is a medical student at the Pritzker School of Medicine, University of Chicago.
Health Aff (Millwood). 2017 Jun 1;36(6):1133-1139. doi: 10.1377/hlthaff.2016.0979.
Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers' intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential.
支付系统通常不会直接鼓励或支持减少健康差距。2013 年，罗伯特伍德约翰逊基金会的“寻找答案：通过支付和交付系统改革解决差异”计划旨在了解替代支付模式如何有意纳入减少差异的组成部分，以促进健康公平。对该计划的 40 项提案的定性分析表明，申请人通常没有将支付改革与减少差异紧密联系起来。大多数人提议实行一般的按绩效付费、总额支付或共享储蓄计划，并结合多方面的系统干预措施。没有申请人提议将任何财务支付与成功减少差异挂钩。大多数申请人没有说明他们将如何优化提供者减少差异的内在和外在动机。更好地理解支付和医疗服务模式如何设计和实施以减少健康差距至关重要。
