Dudley R A, Miller R H, Korenbrot T Y, Luft H S
Institute for Health Policy Studies, University of California, San Francisco 94109, USA.
Milbank Q. 1998;76(4):649-86, 511. doi: 10.1111/1468-0009.00109.
Purchasers of health care could offer financial incentives to plans or providers in order to increase quality. Unfortunately, the current health care market, in which quality is rarely measured and there is no risk adjustment, actively discourages both plans and providers from maximizing quality, resulting in a poor overall level of quality, both in fee-for-service arrangements and health maintenance organizations. Health plans and providers will not focus on quality until mechanisms to correct for risk differences among enrollees can be developed. Although such risk adjustment will be the most important stimulus for quality, it should also be linked to improvements in information systems and agreement on a minimum benefits package, quality reporting standards, and financial solvency requirements.
医疗保健购买者可以向保险公司或医疗服务提供者提供经济激励措施，以提高医疗质量。不幸的是，在当前的医疗保健市场中，质量很少得到衡量，也不存在风险调整机制，这实际上阻碍了保险公司和医疗服务提供者将质量最大化，导致无论是在按服务收费模式还是健康维护组织中，整体医疗质量水平都很低。在开发出能够校正参保人之间风险差异的机制之前，健康保险公司和医疗服务提供者不会专注于质量。尽管这种风险调整将是提高质量的最重要刺激因素，但它也应与信息系统的改进以及在最低福利套餐、质量报告标准和财务偿付能力要求方面达成的共识联系起来。
