Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
Scientific Institute for Quality of Healthcare (IQ Healthcare), Celsus Academy for Sustainable Healthcare, Radboudumc, Nijmegen, The Netherlands.
Eur J Health Econ. 2019 Mar;20(2):217-232. doi: 10.1007/s10198-018-0989-8. Epub 2018 Jul 5.
Outcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable effects.
We first developed a definition for OBPMs. Next, we searched four data sources to identify the models: (1) scientific literature databases; (2) websites of relevant governmental and scientific agencies; (3) the reference lists of included articles; (4) experts in the field. We only selected studies that examined the impact of the payment model on quality and/or costs. A narrative evidence synthesis was used to link specific design features to effects on quality of care or healthcare costs.
We included 88 articles, describing 12 OBPMs. We identified two groups of models based on differences in design features: narrow OBPMs (financial incentives based on quality indicators) and broad OBPMs (combination of global budgets, risk sharing, and financial incentives based on quality indicators). Most (5 out of 9) of the narrow OBPMs showed positive effects on quality; the others had mixed (2) or negative (2) effects. The effects of narrow OBPMs on healthcare utilization or costs, however, were unfavourable (3) or unknown (6). All broad OBPMs (3) showed positive effects on quality of care, while reducing healthcare cost growth.
Although strong empirical evidence on the effects of OBPMs on healthcare quality, utilization, and costs is limited, our findings suggest that broad OBPMs may be preferred over narrow OBPMs.
基于成果的支付模式（OBPM）可以通过基于所提供护理成果指标的财务激励来解决按服务收费或诊断相关组（DRG）模式的缺点。本综述分析了 OBPM 的特征和效果，以确定哪些模式会产生有利影响。
我们首先为 OBPM 制定了定义。然后，我们在四个数据源中搜索了模型：（1）科学文献数据库；（2）相关政府和科学机构的网站；（3）纳入文章的参考文献列表；（4）该领域的专家。我们仅选择了研究支付模式对质量和/或成本影响的文章。叙述性证据综合用于将特定设计特征与护理质量或医疗保健成本的影响联系起来。
我们纳入了 88 篇文章，描述了 12 种 OBPM。我们根据设计特征的差异确定了两组模型：（1）狭义 OBPM（基于质量指标的财务激励）和（2）广义 OBPM（全球预算、风险分担和基于质量指标的财务激励的组合）。大多数（9 个中的 5 个）狭义 OBPM 对质量显示出积极影响；其他的则有混合（2）或负面（2）影响。然而，狭义 OBPM 对医疗保健利用或成本的影响是不利的（3）或未知的（6）。所有广义 OBPM（3）都显示出对医疗保健质量的积极影响，同时降低了医疗保健成本的增长。
尽管关于 OBPM 对医疗保健质量、利用和成本影响的有力经验证据有限，但我们的研究结果表明，广义 OBPM 可能优于狭义 OBPM。
