University of Oxford, the Ethox Centre, Nuffield Department of Population Health, Oxford, UK.
Johns Hopkins Outpatient Center, 601 N Caroline St Suite 7143, Baltimore, MD, 21287, USA.
Patient. 2018 Aug;11(4):371-375. doi: 10.1007/s40271-018-0299-3.
We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order to argue how at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals' care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident.
我们讨论了预先授权（PA）在通过引导卫生系统资源来支持以患者为中心的护理（PCC）方面的作用，从而能够更好地满足个体患者的需求。我们首先介绍了 PCC 作为患者护理标准的概念。为了实现广泛的 PCC，医疗保健系统中进行适当的资源管理至关重要。这就引出了 PA，我们提出了 PA 的理想化观点，以论证在最佳情况下，它如何有助于提供 PCC。PA 是一种节省成本的手段，因此其效果参差不齐。美国的例子表明，PA 的实施如何增加了健康不平等，而最佳实践则有可能减少这种不平等。相比之下，像欧洲那样的全民覆盖系统可能会利用 PA 的成本节约来更好地满足个人的护理和 PCC 需求。因此，我们给出的结论是乐观的，指出了 PCC 和 PA 之间存在支持性重叠的领域，通常在这些领域中，不协调现象最为明显。
