De Rosis Sabina, Nuti Sabina
Laboratorio Management e Sanità (MeS), Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy.
Int J Health Plann Manage. 2018 Jan;33(1):e131-e152. doi: 10.1002/hpm.2443. Epub 2017 Aug 8.
eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long-term sustainability. In a public health care system, the public actor is among the main "buyers" eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a "buyer") improve long-term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win-win strategies should be followed. Investments should take into account the need to long-term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the "platform approach" emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes.
电子健康有望为应对医疗保健系统面临的挑战做出贡献。然而，它也带来了挑战。国家和地区层面采用的融资策略广泛影响着电子健康的长期可持续性。在公共医疗保健系统中，公共行为体是电子健康的主要“购买者”之一。然而，公共干预越来越侧重于成本控制。如何平衡这两个方面？本文探讨了在公共医疗保健系统中制定有效且有价值的电子健康策略时的一些核心问题，主要涉及财务方面：公共医疗保健系统（作为“购买者”）如何提高电子健康解决方案的长期成功率和可持续性？在长期内有哪些杠杆可用于协调电子健康领域不同利益相关者的不同利益？在意大利托斯卡纳地区进行了一项案例研究。根据我们的结果，应遵循双赢策略。投资应考虑长期融资解决方案的必要性，以维持医疗保健组织的变革以获取收益。为了解决互操作性问题，基于组织内部和组织之间的合作出现了“平台方法”的概念。电子健康解决方案的私营部门以及受益者和最终用户应参与其设计、提供和监测。为了为所有人创造价值，可以通过一种资金拉动机制来解决证据差距和资金需求问题，该机制旨在根据电子健康解决方案产生的结果进行支付，这基于对结果的持续监测、测量和评估。
