Department of Health, Medicine and Caring Sciences (HMV), Centre for Medical Technology Assessment (CMT), Linköping University, SE-581 83, Linköping, Sweden.
Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden.
BMC Health Serv Res. 2020 Aug 27;20(1):805. doi: 10.1186/s12913-020-05578-8.
Value-based reimbursement programs have become increasingly common. However, little is known about the effect of such programs on patient reported outcomes. Thus, the aim of this study was to analyze the effect of introducing a value-based reimbursement program on patient reported outcome measures and to explore whether a selection bias towards less complicated patients occurred.
This is a retrospective observational study with a before and after design based on the introduction of a value-based reimbursement program in Region Stockholm, Sweden. We analyzed patient level data from inpatient and outpatient care of patients undergoing lumbar spine surgery during 2006-2015. Patient reported outcome measures used was Global Assessment, EQ-5D-3L and Oswestry Disability Index. The case-mix of surgically treated patients was analyzed using medical and socioeconomic factors.
The value-based reimbursement program did not have any effect on targeted or non-targeted patient reported outcome measures. Moreover, the share of surgically treated patients with risk factors such as having comorbidities and being born outside of Europe increased after the introduction. Hence, the value-based reimbursement program did not encourage discrimination against sicker patients. However, the income was higher among patients surgically treated after the introduction of the value-based reimbursement. This indicates that a value-based reimbursement program may contribute to increased inequalities in access to healthcare.
The value-based reimbursement program did not have any effect on patient reported outcome measures. Our study contributes to the understanding of the effects of a value-based reimbursement program on patient reported outcome measures and to what extent cherry-picking arises.
基于价值的报销计划已变得越来越普遍。然而，对于此类计划对患者报告结果的影响知之甚少。因此，本研究的目的是分析引入基于价值的报销计划对患者报告结果测量的影响，并探讨是否存在对较简单患者的选择偏倚。
这是一项基于瑞典斯德哥尔摩地区引入基于价值的报销计划的回顾性观察性研究，采用前后设计。我们分析了 2006-2015 年接受腰椎手术的住院和门诊患者的患者水平数据。使用的患者报告结果测量指标为总体评估、EQ-5D-3L 和 Oswestry 残疾指数。使用医疗和社会经济因素分析接受手术治疗的患者的病例组合。
基于价值的报销计划对有针对性和非针对性的患者报告结果测量均没有任何影响。此外，在引入之后，患有合并症和出生在欧洲以外的患者等风险因素的接受手术治疗的患者比例增加。因此，基于价值的报销计划并未鼓励歧视更严重的患者。然而，在引入基于价值的报销之后，接受手术治疗的患者的收入更高。这表明，基于价值的报销计划可能会导致获得医疗保健的不平等加剧。
基于价值的报销计划对患者报告结果测量均没有任何影响。我们的研究有助于了解基于价值的报销计划对患者报告结果测量的影响以及出现选择偏倚的程度。
