一个低门诊所治疗阿片类药物使用障碍的成本模型
Sarah E Wakeman1,2, Elizabeth Powell3, Syed Shehab4
1Department of Medicine, Massachusetts General Hospital, Boston, USA.
The journal of behavioral health services & research
|August 29, 2023
概括
目前的美国支付系统还不够支付阿片类药物使用障碍 (OUD) 诊所的费用. 一项新的成本分析揭示了患者成本的显著变化,支持为可持续的OUD治疗准入提供量身定制的支付模式.
科学领域:
- 卫生经济学 卫生经济学
- 药物使用障碍治疗 药物使用障碍治疗
- 医疗保健管理的管理
背景情况:
- 美国的服务费模式不充分补偿提供全面阿片类药物使用障碍 (OUD) 治疗的诊所.
- 这种资金缺口阻碍了诊所的扩张和获取,特别是对于边缘化群体.
- 现有的支付结构无法考虑与不同患者需求和服务利用相关的各种成本.
研究的目的:
- 估计提供阿片类药物使用障碍 (MOUD) 药物和相关支持服务的实际成本.
- 分析基于患者复杂性和治疗强度的成本变化.
- 为开发OUD护理公平和可持续的替代支付模式提供基础.
主要方法:
- 应用基于时间驱动的基于活动的成本计算 (TDABC),一种患者层面的微成本计算方法.
- 从提供MOUD和自愿心理社会/康复支持服务的门诊收集成本数据.
- 将患者分为三个原型:轻触 (1-3次访问),标准 (平均) 基于临床和社会因素的八次访问),四次死亡率 (>20次访问).
主要成果:
- 在患者原型中发现了显著的成本差异.
- 索引成本 (初次访问=100) 是:轻触 (352),标准 (718) 和四重病率 (1701).
- 患者的复杂性 (同时发生的疾病,住房状况,社会支持) 显著推动了成本差异.
结论:
- 目前的补偿制度需要改革,以反映OUD治疗的真实成本.
- 将患者分为原型的分层对于理解成本驱动因素和告知支付模式至关重要.
- 基于这些成本结构的新支付模式的开发可以支持可访问,多学科的MOUD诊所的建立和可持续性.
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