Hsiao W C, Braun P, Yntema D, Becker E R
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115.
N Engl J Med. 1988 Sep 29;319(13):835-41. doi: 10.1056/NEJM198809293191305.
We have developed a resource-based relative-value scale as an alternative to the system of payment based on charges for physicians' services. Resource inputs by physicians include (1) total work input performed by the physician for each service; (2) practice costs, including malpractice premiums; and (3) the cost of specialty training. These factors were combined to produce a relative-value scale denominated in nonmonetary units. We describe here the process by which the physician's work was defined and estimated. The study asked two questions: What is the physician's work for each service performed? and Can work be estimated reliably and validly? We concluded that a physician's work has four major dimensions: time, mental effort and judgment, technical skill and physical effort, and psychological stress. We found that physicians can rate the relative amount of work of the services within their specialty directly, taking into account all the dimensions of work. Moreover, these ratings are highly reproducible, consistent, and therefore probably valid.
我们开发了一种基于资源的相对价值量表，作为基于医生服务收费的支付系统的替代方案。医生的资源投入包括：（1）医生为每项服务执行的总工作投入；（2）执业成本，包括医疗事故保险费；以及（3）专科培训成本。这些因素被综合起来，以产生一个以非货币单位计价的相对价值量表。我们在此描述定义和估算医生工作的过程。该研究提出了两个问题：医生为每项执行的服务付出的工作是什么？以及工作能否被可靠且有效地估算？我们得出结论，医生的工作有四个主要维度：时间、脑力劳动与判断、技术技能与体力劳动以及心理压力。我们发现，医生能够直接对其专业领域内各项服务的相对工作量进行评分，同时考虑到工作的所有维度。此外，这些评分具有高度的可重复性、一致性，因此可能是有效的。
