评估加利福尼亚州努力减少不必要的医疗保健过度使用的社会价值。
Assessing social values for California's efforts to reduce the overuse of unnecessary medical care.
机构信息
Department of Kinesiology and Health Science, California State University, Sacramento, CA, USA.
California Department of Health Care Services and University of California, Davis Institute for Population Health Improvement, Sacramento, CA, USA.
出版信息
Health Expect. 2018 Apr;21(2):501-507. doi: 10.1111/hex.12644. Epub 2017 Nov 16.
BACKGROUND
A partnership of large health-care purchasers created a workgroup to reduce the overuse of harmful and wasteful medical care in California.
OBJECTIVE
Employ a civic engagement process to identify the social values important to the public in considering different strategies to reduce overuse.
INTERVENTION
Use of deliberation techniques for 3 case examples that explore possible strategies: physician oversight, physician compensation, increased patient cost-sharing or taking no definitive action.
RESULTS
Five themes were identified, including strong support for physicians' leadership role to reduce overuse; nuanced enthusiasm for increasing patient cost-sharing to discourage excessive demand; and marked disapproval of physician compensation as a motivator.
CONCLUSION
Most but not all of the perspectives voiced by participants are congruent with efforts to reduce overuse that is being initiated or discussed at the state, provider and health plan level. As health-care policymakers and leaders consider more targeted approaches to reducing overuse, these findings will inform decision-making.
背景
大型医疗保健购买方的合作关系成立了一个工作组，旨在减少加利福尼亚州有害和浪费性医疗的过度使用。
目的
采用公民参与流程来确定公众在考虑减少过度使用的不同策略时的重要社会价值观。
干预措施
使用审议技术对 3 个案例进行探讨，这些案例探索了可能的策略：医生监督、医生薪酬、增加患者自付费用或不采取明确行动。
结果
确定了五个主题，包括对医生在减少过度使用方面的领导作用的大力支持；对增加患者自付费用以抑制过度需求的细微热情；以及对医生薪酬作为激励措施的明显反对。
结论
大多数但不是所有参与者表达的观点都与正在州、提供者和健康计划层面发起或讨论的减少过度使用的努力相一致。随着医疗保健政策制定者和领导者考虑更有针对性的减少过度使用的方法，这些发现将为决策提供信息。
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