Abhinav Pandey (
Diana Eastman, Grow Therapy, New York, New York.
Health Aff (Millwood). 2023 Jun;42(6):813-821. doi: 10.1377/hlthaff.2022.01455.
During the past two decades in the United States, all major payer types-commercial, Medicare, Medicaid, and multipayer coalitions-have introduced value-based purchasing (VBP) contracts to reward providers for improving health care quality while reducing spending. This systematic review qualitatively characterized the financial and nonfinancial features of VBP programs and examined how such features combine to create a level of program intensity that relates to desired quality and spending outcomes. Higher-intensity VBP programs are more frequently associated with desired quality processes, utilization measures, and spending reductions than lower-intensity programs. Thus, although there may be reasons for payers and providers to opt for lower-intensity programs (for example, to increase voluntary participation), these choices apparently have consequences for spending and quality outcomes.
在过去的二十年中，美国的所有主要付费方类型——商业、医疗保险、医疗补助和多方联盟——都引入了基于价值的购买（VBP）合同，以奖励提供者改善医疗保健质量，同时降低支出。本系统评价从定性上描述了 VBP 计划的财务和非财务特征，并研究了这些特征如何结合起来形成与期望的质量和支出结果相关的计划强度水平。与低强度计划相比，高强度 VBP 计划更频繁地与期望的质量流程、利用措施和支出减少相关。因此，尽管付费方和提供者可能有选择低强度计划的原因（例如，增加自愿参与），但这些选择显然会对支出和质量结果产生影响。
