Kazungu Jacob S, Barasa Edwine W, Obadha Melvin, Chuma Jane
Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya.
Nuffield Department of Medicine, Oxford University, Oxford, UK.
Int J Health Plann Manage. 2018 Oct;33(4):e892-e905. doi: 10.1002/hpm.2565. Epub 2018 Jul 8.
Provider payment mechanisms (PPMs) create incentives or signals that influence the behaviour of health care providers. Understanding the characteristics of PPMs that influence health care providers' behaviour is essential for aligning PPM reforms for improving access, quality, and efficiency of health care services. We reviewed empirical literature that examined the characteristics of PPMs that influence the behaviour of health care providers.
We systematically searched for empirical literature in PubMed, Web of Science, and Google Scholar databases and complemented these with physical searching of the references of selected papers for further relevant studies. A total of 16 studies that met our inclusion and exclusion criteria were identified. We analysed data using thematic review.
We identified seven major characteristics of PPMs that influence health care providers' behaviour. Of these characteristics, payment rate, the sufficiency of payment rate to cover the cost of services, timeliness of payment, payment schedule, performance requirements, and accountability mechanisms were the most important.
Our review found that health care providers' behaviour is influenced by the characteristics of PPMs. Provider payment mechanism reforms that optimally structure these characteristics can elicit required incentives for access, equity, quality, and efficiency in service delivery among health care providers towards achieving universal health coverage.
医疗服务提供者支付机制（PPMs）会产生影响医疗服务提供者行为的激励措施或信号。了解影响医疗服务提供者行为的PPMs特征对于调整PPM改革以提高医疗服务的可及性、质量和效率至关重要。我们回顾了实证文献，这些文献研究了影响医疗服务提供者行为的PPMs特征。
我们在PubMed、科学网和谷歌学术数据库中系统地搜索实证文献，并通过对所选论文的参考文献进行实地搜索来补充这些文献，以寻找更多相关研究。共确定了16项符合我们纳入和排除标准的研究。我们使用主题综述分析数据。
我们确定了影响医疗服务提供者行为的PPMs的七个主要特征。在这些特征中，支付率、支付率覆盖服务成本的充足性、支付及时性、支付时间表、绩效要求和问责机制最为重要。
我们的综述发现，医疗服务提供者的行为受到PPMs特征的影响。优化构建这些特征的医疗服务提供者支付机制改革可以在医疗服务提供者中激发实现全民健康覆盖所需的服务可及性、公平性、质量和效率方面的激励措施。
