Remers Toine E P, Nieuweweme Nina, van Dulmen Simone A, Rikkert Marcel Olde, Jeurissen Patrick P T
Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, NL.
Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatrics, Radboudumc Alzheimer Center, Nijmegen, NL.
Int J Integr Care. 2022 Feb 10;22(1):10. doi: 10.5334/ijic.5937. eCollection 2022 Jan-Mar.
Inadequate treatment of multimorbidity is recognised as a major determinant of the effectiveness of healthcare and also of its inappropriate expenditures. However, current payment systems target, primarily, the treatment of single diseases, thus hindering integrated delivery of care for patients with multimorbidity (PwM). This review aims to assess the effects of targeted reforms of payment systems which could help attain a higher quality of care and reduce unnecessary healthcare utilisation. In June 2020, a search of Medline and EMBASE revealed 13 relevant articles. The most common payment models were the use of bundled payments (n = 4) and diagnosis-related group payments (n = 4). Except for an increase in hospital admissions (n = 3), no outcome showed unambiguous significant effects across more than one study. The two studies which focused explicitly on PwM showed a significant decrease in 30-day hospital readmissions. This, however, was not maintained after 60 days in one study. No general conclusion could be drawn on the effects of targeted payment reforms for PwM. Our findings suggest that reforms should be combined with more multifaceted healthcare delivery to address the complex patterns of healthcare use effectively. Thorough evaluations of targeted payment reforms are needed urgently to contribute to the body of evidence required.
多重疾病治疗不充分被认为是医疗保健效果及其不当支出的主要决定因素。然而，当前的支付系统主要针对单一疾病的治疗，从而阻碍了对患有多重疾病的患者（PwM）进行综合护理。本综述旨在评估支付系统有针对性改革的效果，这些改革有助于提高护理质量并减少不必要的医疗保健利用。2020年6月，对Medline和EMBASE的检索发现了13篇相关文章。最常见的支付模式是使用捆绑支付（n = 4）和诊断相关分组支付（n = 4）。除了住院人数增加（n = 3）外，没有任何结果在一项以上的研究中显示出明确的显著效果。两项明确针对PwM的研究显示，30天内再次入院的人数显著减少。然而，在一项研究中，60天后这种情况并未持续。对于针对PwM的有针对性支付改革的效果，无法得出一般性结论。我们的研究结果表明，改革应与更全面的医疗保健服务相结合，以有效应对复杂的医疗保健使用模式。迫切需要对有针对性的支付改革进行全面评估，以补充所需的证据。
