Helmchen Lorens A, Encinosa William E, Chernew Michael E, Hirth Richard A
Department of Health Administration and Policy, George Mason University.,
Agency for Healthcare Research and Quality, and Adjunct Associate Professor, Georgetown Public Policy Institute.
Forum Health Econ Policy. 2013 Jan;16(1):123-136. doi: 10.1515/fhep-2012-0002. Epub 2013 Apr 15.
To rein in cost, payers are exploring bundled payment, which aggregates fees for a range of services into a single prospective payment. While under bundled payment providers would have incentives to reduce cost, they might also withhold more expensive care that patients prefer. We explore how bundled payment could be aligned with a benefit design that would encourage patients' consideration of cost without jeopardizing access to the most expensive treatments. Least-costly-alternative approaches allow patient choice but might deter patients from choosing more expensive care by exposing them to potentially large out-of-pocket payments. A novel "shared-savings supplement" would reward patients for choosing the least costly alternative with a supplemental cash disbursement and thus allow them to share in any cost savings. This cash incentive for the least-costly-alternative allows a reduction of the out-of-pocket payment for the expensive alternative. Thus, patients would still have the option of the more expensive therapy while facing only a modest out-of-pocket cost. Such benefit modifications could be aligned with bundled payment by splitting the responsibility for the incremental cost of more expensive care between patients and their providers.
为了控制成本，支付方正在探索捆绑支付，即将一系列服务的费用汇总为单一的预期支付。虽然在捆绑支付模式下，医疗服务提供者有降低成本的动机，但他们也可能会拒绝提供患者更倾向的昂贵治疗。我们探讨了如何使捆绑支付与一种福利设计相结合，这种福利设计既能鼓励患者考虑成本，又不会危及他们获得最昂贵治疗的机会。成本最低替代方案允许患者进行选择，但可能会让患者因面临潜在的高额自付费用而不敢选择更昂贵的治疗。一种新颖的“共享节约补贴”将通过额外的现金支付奖励选择成本最低替代方案的患者，从而让他们分享成本节约。这种针对成本最低替代方案的现金激励可以减少昂贵替代方案的自付费用。因此，患者在面临适度自付成本的情况下，仍可选择更昂贵的治疗方案。通过在患者及其医疗服务提供者之间分担更昂贵治疗的增量成本，这种福利调整可以与捆绑支付相结合。
