Dunbar-Rees Rupert
Outcomes Based Healthcare, London, UK.
Future Healthc J. 2018 Jun;5(2):98-102. doi: 10.7861/futurehosp.5-2-98.
Payment by results' (PbR) is probably one of the most widely debated misnomers in the NHS. At best, rather than reimbursing results, it can be considered as payment for providing collections of acute care activities. Better prevention is often cited as the only solution to sustainability, but currencies which reward prevention seemingly remain very hard to create. This review article explores the impact of legacy payment systems on health and care systems nationally and internationally. It examines alternative models, such as payment for outcomes, and questions whether any alternative payment systems may better support prevention, and finally achieve the 'holy grail' of a truly sustainable care system. If payment for outcomes offers a potential solution, then what are the key barriers and enablers? The case for alternative, novel metrics for success is proposed, which may better support care systems to measure their progress towards sustainability than existing indicators.
“按结果付费”（PbR）可能是英国国家医疗服务体系（NHS）中争议最大、名不副实的术语之一。充其量，它并非对结果进行报销，而可被视为对提供急性护理活动集合的付费。更好的预防措施常被视为实现可持续性的唯一解决方案，但奖励预防措施的机制似乎仍很难建立。这篇综述文章探讨了传统支付系统在国内和国际上对卫生和医疗系统的影响。它研究了替代模式，如按结果付费，并质疑是否有任何替代支付系统能更好地支持预防工作，最终实现真正可持续医疗系统的“圣杯”。如果按结果付费提供了一个潜在的解决方案，那么关键障碍和推动因素是什么？文章提出了采用替代的、新颖的成功衡量标准的理由，与现有指标相比，这些标准可能更好地支持医疗系统衡量其在实现可持续性方面的进展。
