美国卫生系统的组织和表现
Nancy D Beaulieu1, Michael E Chernew1,2, J Michael McWilliams1,3
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
JAMA
|January 24, 2023
概括
医疗系统提供了很大一部分医疗服务,质量略有提高,但成本和价格明显上升. 这表明卫生系统尚未实现以更低的成本提供更好的护理的目标.
科学领域:
- 医疗服务研究
- 健康经济学
- 医疗保健管理
背景情况:
- 医疗系统是医疗服务的核心,但其组织性能仍未得到充分研究.
- 了解卫生系统的特点和影响对于评估医疗保健效率和质量至关重要.
研究的目的:
- 确定和描述美国的卫生系统.
- 为了比较医生和医院在内外的卫生系统.
- 评估医生和医院提供的医疗服务的质量和成本.
主要方法:
- 基于所有权/管理,医院存在和医生数量在医院转诊区域内定义的卫生系统.
- 使用医疗保险和医疗补助服务中心的数据,国税局的文件,以及用于识别和分类的索赔数据 (学术,公共,营利,非营利,私人).
- 对医疗保险受益者和商业索赔的评估质量 (预防性护理,慢性疾病管理,患者经验,低价值护理,死亡率,再接收) 和成本 (价格,支出),调整为患者和地理因素.
主要成果:
- 确定了580个不同的卫生系统;它们占医生的40%,占医院床位的84%,为医疗保险受益者提供了41%.
- 医疗系统的医生和医院在预防性护理,临床质量和患者体验方面表现较好.
- 在医疗系统中,服务价格显著上升 (12%-26%的医生,31%的医院),其中小型诊所的价格差异很大.
结论:
- 医疗系统提供了大量的护理,质量稍有改善,但成本显著上升.
- 观察到的价格和质量差异表明,卫生系统并未始终实现以更低的成本提供更好的护理的目标.
- 价格差异,特别是在较小的实践中,突出了医疗系统潜在的成本控制策略的低效性和领域.
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