医疗保险公司参与医疗保健采购决策：荷兰的最新经验。
Citizen engagement in healthcare procurement decision-making by healthcare insurers: recent experiences in the Netherlands.
机构信息
Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
Amsterdam UMC location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands.
出版信息
Health Res Policy Syst. 2022 Dec 22;20(1):137. doi: 10.1186/s12961-022-00939-7.
BACKGROUND
In insurance-based healthcare systems, healthcare insurers are interested in engaging citizens in care procurement to contract healthcare services that matter to people. In the Netherlands, an amendment to the Health Insurance Act was set forth in 2021 to formalize and strengthen the engagement of the insured population with healthcare insurers' procurement cycles. This study explores the role of Dutch healthcare insurers in operationalizing citizen engagement in procurement cycles before changes occur linked to the amendment to the Health Insurance Act.
METHODS
A phenomenological qualitative design was employed in two phases: (1) we consulted academics and policy experts on the role of healthcare insurers regarding citizen engagement; (2) we conducted focus groups with representatives of healthcare insurers to understand how citizens' engagement is being operationalized. Transcripts of the interviews with experts and detailed notes of focus group meetings were analysed using a qualitative inductive approach. Selected excerpts were analysed on discourse and content and organized by a coding scheme following a rigorous and accelerated data reduction technique.
RESULTS
We identified four strategies used by healthcare insurers to operationalize citizen engagement: (1) broadening their population health orientation; (2) developing and improving mechanisms for engaging citizens; (3) strengthening features of data governance for effective use of value-driven data; (4) implementing financial and incentive mechanisms among healthcare providers in support of value-based healthcare. However, regulated market mechanisms and low institutional trust in healthcare insurers undermine their transition from merely funding healthcare towards becoming people-centred value-based healthcare purchasers.
CONCLUSION
Dutch healthcare insurers seem to be strengthening the community orientation of their functioning while enhancing the end-to-end experience of the insured. The expected practical effects of the amendment to the Health Insurance Act include broadening the role of the council of insurees in decision-making processes and systematically documenting the efforts set forth by healthcare insurers in engaging citizens. Further research is needed to better understand how the regulated competitive market could be hampering the engagement of citizens in healthcare procurement decision-making and value creation from the citizens' perspective.
背景
在以保险为基础的医疗保健系统中，医疗保健保险公司有兴趣让公民参与医疗保健服务的采购，以提供对人们重要的医疗保健服务。在荷兰，2021 年对《医疗保险法》进行了修订，旨在使参保人群与医疗保健保险公司的采购周期之间的互动正式化并得到加强。本研究旨在探讨荷兰医疗保健保险公司在《医疗保险法》修订之前，在运营层面让公民参与采购周期的角色。
方法
本研究采用了现象学定性设计，分为两个阶段：（1）我们就医疗保健保险公司在公民参与方面的作用咨询了学者和政策专家；（2）我们与医疗保健保险公司的代表进行了焦点小组讨论，以了解公民参与是如何被实施的。对专家访谈的记录和焦点小组会议的详细笔记进行了定性归纳分析。使用严格的加速数据缩减技术，根据话语和内容对选定的摘录进行分析，并按照编码方案进行组织。
结果
我们确定了医疗保健保险公司用来实施公民参与的四种策略：（1）拓宽其人口健康导向；（2）开发和改进吸引公民参与的机制；（3）加强数据治理的特点，以有效利用价值驱动的数据；（4）在医疗保健提供者中实施财务和激励机制，以支持基于价值的医疗保健。然而，受监管的市场机制和对医疗保健保险公司的低机构信任，阻碍了它们从仅仅为医疗保健提供资金向以人为本的基于价值的医疗保健购买者的转变。
结论
荷兰医疗保健保险公司似乎正在加强其运作的社区导向，同时增强参保人的端到端体验。《医疗保险法》修订的预期实际效果包括扩大被保险人理事会在决策过程中的作用，并系统地记录医疗保健保险公司在吸引公民参与和从公民角度创造医疗保健采购决策和价值方面所做的努力。需要进一步研究，以更好地了解受监管的竞争市场如何阻碍公民参与医疗保健采购决策和从公民角度创造价值。
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