ハワイでは,人口ベースのプライマリーケア支払い制度の実施と,品質対策の達成との関連
Amol S Navathe1,2,3,4,5, Ezekiel J Emanuel2,3, Amelia Bond6
1Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
JAMA
|July 3, 2019
まとめ
ハワイ医療サービス協会のプライマリケアに対する人口ベースの支払い (3PC) は,その最初の年に品質の向上とプライマリケア訪問の減少を示しました. 医療費の総額には大きな影響はなかった.
科学分野:
- 医療サービス研究
- 医療費の支払い方法
- 初等医療の質の向上
背景:
- ハワイ医療サービス協会 (HMSA) は,2016年に新規のキャピテーションベースの支払いシステム,人口ベースのプライマリケア支払い (3PC) を導入した.
- この支払い改革が医療の質,利用,支出に与える影響は未評価のままです.
研究 の 目的:
- 3PCの支払いシステムと品質の測定,医療の利用,および実施の最初の年のコストの変化との関連を評価する.
- ハワイのプライマリケア補償の 重要な変化を早期に評価する
主な方法:
- 2012年から2016年のHMSAの主張と臨床登録データを活用した観察研究.
- 傾向による差異分析で,3PCに参加した医師とサービス代償モデルに割り当てられたメンバーを比較した.
主要な成果:
- 3PCシステムでは,複合品質測定のスコアが統計的に有意に改善された (非3PCグループより2. 3パーセントポイント高い).
- 3PCグループでは,非3PCグループと比較して,初等医療訪問の有意な減少が観察された (- 3. 9%の調整された差異変化).
- この2つのグループでは,治療費の総額で有意な差は認められませんでした.
結論:
- ハワイの3PC支払いシステムの最初の年は,医療費全体に影響を与えることなく,質の改善と初等医療利用の減少を示しました.
- この支払いモデルの長期的な効果と一般化性を理解するために,さらなる調査が必要である.
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