Harvard Medical School.
University of Texas MD Anderson Cancer Center and Baker Institute for Public Policy, Rice University.
Milbank Q. 2023 Apr;101(S1):866-892. doi: 10.1111/1468-0009.12632.
Policy Points The predominantly fee-for-service reimbursement architecture of the US health care system contributes to waste and excess spending. While the past decade of payment reforms has galvanized the adoption of alternative payment models and generated moderate savings, uptake of truly population-based payment systems continues to lag, and interventions to date have had limited impact on care quality, outcomes, and health equity. To realize the promise of payment reforms as instruments for delivery system transformation, future policies for health care financing must focus on accelerating the diffusion of value-based payment, leveraging payments to redress inequities, and incentivizing partnerships with cross-sector entities to invest in the upstream drivers of health.
美国医疗保健系统主要采用按服务项目收费的报销架构,导致了浪费和过度支出。尽管过去十年的支付改革推动了替代支付模式的采用,并产生了适度的节省,但真正基于人群的支付系统的采用仍在滞后,迄今为止的干预措施对护理质量、结果和健康公平的影响有限。为了实现支付改革作为交付系统转型工具的承诺,未来的医疗保健融资政策必须专注于加速基于价值的支付的扩散,利用支付来纠正不平等,并激励与跨部门实体建立伙伴关系,投资于健康的上游驱动因素。