Kindig D A
Wisconsin Network for Health Policy Research, University of Wisconsin-Madison School of Medicine, 227 Bradley Memorial Hospital 53706-1532, USA.
Health Serv Res. 1998 Jun;33(2 Pt 1):223-42.
To review the concept of population health, including its definition, measurement, and determinants, and to suggest an approach for aligning financial incentives toward this goal. DATA SOURCE, STUDY DESIGN, DATA EXTRACTION. Literature review, policy analysis
The article presents the argument that a major reason for our slow progress toward health outcome improvement is that there is no operational definition of population health and that financial incentives are not aligned to this goal. Current attempts at process measures as indicators of quality or outcome are not adequate for the task. It is suggested that some measure of health-adjusted life expectancy be adopted for this purpose, and that integrated delivery systems and other agents responsible for nonmedical determinants be rewarded for improvement in this measure. This will require the development of an investment portfolio across the determinants of health based on relative marginal return to health, with horizontal integration strategies across sectoral boundaries. A 20-year three-phase development strategy is proposed, including components of research and acceptance, integrated health system implementation, and cross-sectoral integration.
The U.S. healthcare system is a $1 trillion industry without a definition of its product. Until population outcome measures are developed and rewarded for, we will not solve the twenty-first century challenge of maximizing health outcome improvement for the resources available.
回顾人群健康的概念，包括其定义、衡量方法和决定因素，并提出一种使财务激励措施与该目标保持一致的方法。数据来源、研究设计、数据提取。文献综述、政策分析
本文提出的观点是，我们在改善健康结果方面进展缓慢的一个主要原因是缺乏人群健康的可操作定义，且财务激励措施未与该目标保持一致。目前将过程指标作为质量或结果指标的尝试不足以完成这项任务。建议为此采用某种健康调整预期寿命的衡量方法，并对综合医疗服务体系和其他负责非医疗决定因素的机构在这一衡量指标上的改善给予奖励。这将需要根据对健康的相对边际回报，制定一个涵盖健康决定因素的投资组合，并采取跨部门边界的横向整合策略。提出了一个为期20年的三阶段发展战略，包括研究与接受、综合医疗体系实施以及跨部门整合等部分。
美国医疗保健系统是一个规模达1万亿美元的产业，却没有对其产品进行定义。在制定并奖励人群结果指标之前，我们无法应对21世纪的挑战，即如何利用现有资源最大限度地改善健康结果。
