Wyszewianski L, Thomas J W, Friedman B A
Inquiry. 1987 Spring;24(1):17-25.
Case-based payment systems are rapidly becoming the dominant force in current efforts to control hospital inpatient expenditures. But as reliance on them grows, so does the fear that some, if not all, of the resulting reductions in costs will be achieved at the expense of lowering quality of care. In this paper we argue that such fears, while justified, may keep us from recognizing the positive effect that case-based payment systems can have on quality of care: These new payment systems are likely to foster controls that, to the extent they are successful in increasing efficiency, are also well suited to the control of quality of care. We discuss how and why hospitals can be expected to adopt control systems that are explicitly aimed at enhancing both efficiency and quality.
基于病例的支付系统正迅速成为当前控制医院住院费用努力中的主导力量。但随着对它们的依赖增加，人们也越来越担心，即使不是全部，由此产生的部分成本降低将以牺牲医疗质量为代价。在本文中，我们认为这种担忧虽然合理，但可能会使我们无法认识到基于病例的支付系统对医疗质量可能产生的积极影响：这些新的支付系统可能会促进一些控制措施，只要它们在提高效率方面取得成功，就同样适合于控制医疗质量。我们讨论了医院有望如何以及为何采用明确旨在提高效率和质量的控制系统。
