Bernstein David N, Calfee Ryan P, Hammert Warren C, Rozental Tamara D, Witkowski Mary L, Porter Michael E
Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, MA; Institute for Strategy & Competitiveness, Harvard Business School, Boston, MA.
Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO.
J Hand Surg Am. 2022 Oct;47(10):999-1004. doi: 10.1016/j.jhsa.2022.06.019. Epub 2022 Aug 6.
Health care delivery is broken. The cost of care continues to skyrocket and the outcomes most important to patients are often a mystery. Further, care is often delivered via a fee-for-service model where surgeons are rewarded for the quantity, not the quality, of services provided. Such a health care delivery system is not sustainable and does not incentivize stakeholders to focus on the most important element of the health care delivery "puzzle": the patient. Fortunately, we are in the midst of transforming our health care delivery system, with a focus on optimizing the value of care delivery (ie, health outcomes achieved per dollar spent across a full care cycle). In hand surgery, progress has been made as part of this health system evolution. However, there remains much to accomplish. In this article, the authors review the 6 components of a strategic agenda for moving to a high-value health care delivery system for hand surgery, focusing on where we are today and where we need to go from here.
医疗服务体系存在缺陷。医疗成本持续飙升，而对患者最重要的治疗结果却常常成谜。此外，医疗服务通常采用按服务收费模式，外科医生因提供服务的数量而非质量而获得报酬。这样的医疗服务体系不可持续，也无法激励利益相关者关注医疗服务“拼图”中最重要的元素：患者。幸运的是，我们正在对医疗服务体系进行变革，重点是优化医疗服务的价值（即整个护理周期内每花费一美元所取得的健康结果）。在手外科领域，作为这一医疗体系演变的一部分已经取得了进展。然而，仍有许多工作要做。在本文中，作者回顾了转向高价值手外科医疗服务体系战略议程的六个组成部分，重点关注我们目前的状况以及从这里需要迈向的方向。
