Leatt P, Pink G H, Naylor C D
Department of Health Administration, University of Toronto, Ontario.
CMAJ. 1996 Mar 15;154(6):803-9.
In the 1990s every Canadian province is struggling to reduce health care expenditures without jeopardizing access to health care or quality of care. The authors propose a new model for health care delivery: the Canadian Integrated Delivery System (CIDS). A CIDS is a network of health care organizations; it would provide, or arrange to provide, a coordinated continuum of services to a defined population and would be held clinically and fiscally accountable for the outcomes in and health status of that population. A CIDS would serve 100,000 to 2 million people; the care it would provide would be funded on a capitation basis. For providers, there would be explicit financial incentives to minimize costs. At the same time, service quality and consumer choice of primary care practitioner would be maintained. Primary care physicians and specialists would work with other health care service providers to offer a full spectrum of care. CIDS providers would form strategic alliances with community agencies, hospitals, the private sector and other health care services not managed by the CIDS, as needed. For physicians, affiliation with a CIDS that provided strong clinical leadership could be beneficial to their income stability and autonomy. Pilot projects of this model in several communities would determine whether this concept is feasible in the Canadian health care context.
20世纪90年代，加拿大每个省份都在努力削减医疗保健支出，同时又不危及医疗保健的可及性或医疗质量。作者们提出了一种新的医疗服务提供模式：加拿大综合服务系统（CIDS）。CIDS是一个医疗保健组织网络；它将为特定人群提供或安排提供协调一致的连续服务，并将对该人群的医疗结果和健康状况承担临床和财务责任。一个CIDS将服务10万至200万人；它提供的医疗服务将按人头收费。对于医疗服务提供者来说，将有明确的经济激励措施来尽量降低成本。与此同时，服务质量和消费者对初级保健医生的选择将得到维持。初级保健医生和专科医生将与其他医疗服务提供者合作，提供全方位的医疗服务。CIDS提供者将根据需要与社区机构、医院、私营部门以及其他不由CIDS管理的医疗服务建立战略联盟。对于医生来说，加入一个能提供强有力临床领导的CIDS可能有利于他们的收入稳定性和自主权。在几个社区开展的该模式试点项目将确定这一概念在加拿大医疗保健环境中是否可行。
