Boyer C A, Mechanic D
Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08903.
Milbank Q. 1994;72(4):621-51.
The failure of an innovative and ambitious reform in the psychiatric reimbursement system of New York State is examined for specific lessons of value for other states as they implement new payment strategies to encourage improved treatment of the mentally ill in general hospitals and community settings. The New York payment system was comprehensive, embracing both inpatient and outpatient care, and had significant support in the hospital and professional communities. Still, its impact on hospital performance was small and only partially consistent with its goals. For mental health reimbursement reform to succeed, state administrators must provide more clear, sustained, and forceful signals that take account of the real barriers to implementation; they must also ensure that the financial incentives and rewards are recognized by those who carry out the actions needed to translate goals into reality.
纽约州精神科报销制度一项创新且雄心勃勃的改革失败了，本文对其进行审视，旨在为其他州提供具有参考价值的具体经验教训，这些州正在实施新的支付策略，以鼓励综合医院和社区环境中改善对精神病患者的治疗。纽约州的支付系统很全面，涵盖住院和门诊护理，并且在医院和专业团体中获得了大力支持。然而，它对医院绩效的影响很小，而且只是部分符合其目标。要使精神健康报销改革取得成功，州管理人员必须发出更明确、持续且有力的信号，同时要考虑到实施过程中的实际障碍；他们还必须确保那些为将目标转化为现实而采取行动的人认可财务激励措施和奖励。
