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雇用者が価値ベースの購入戦略を使用する
Meredith B Rosenthal1, Bruce E Landon, Sharon-Lise T Normand
1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, USA. mrosenth@hsph.harvard.edu
JAMA
|November 22, 2007
まとめ
雇用者は,価値ベースの購入戦略を広く使用していない. 医療プランや医師の品質データを調査したり,利用したりして,業績に報い,従業員の選択に影響を与える企業はほとんどありません.
科学分野:
- 医療サービス 研究 医療サービス
- 健康経済学 医療経済学
- 医療の質の向上 医療の質の向上
背景:
- 価値ベースの購入 (VBP) は,医療品質の改善を推進する理論です.
- 大規模な雇用者がVBPに参加している一方で,雇用主主催の健康保険の間でその採用は不明です.
研究 の 目的:
- 医療購入者による価値ベースの購入の利用を体系的に記述し,分析する.
- 購入戦略を通じて介護の質を改善するための雇用者の努力を評価する.
主な方法:
- 41の多様な市場における米国の大企業の609人の幹部に電話インタビューを実施した.
- この研究では,雇用者を対象に,業績の報酬と従業員の選択に影響を与えるための品質データの使用について調査を行った.
- データ収集は2005年7月から2006年3月にかけて行われ,回答率は64%であった.
主要な成果:
- 雇用者の65%が健康保険の品質データを調査したが,業績報酬に利用したのは17%に過ぎなかった.
- 医者の品質データについては,雇用者の16%が調査し,業績報酬として利用したのはわずか2%だった.
- 従業員の選択に影響を与えるための品質データの雇用者による使用は,健康プランの23%,医療提供者の8%で限られていた.
結論:
- 雇用者は,平均して,VBPのインセンティブやプログラムを想定した通り個別に実施していない.
- 雇用者の健康保険の購入においてVBPの原則を広く採用することは,まだ実現していない.
- 品質データの検討と,雇用者によるパフォーマンスベースの購入における品質データの適用の間には,大きなギャップがあります.
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