风险选择降低了基于价值的医疗保健的效率
Diogo L L Leao1, Milena Pavlova1, Wim Groot1
1Department of Health Services Research, CAHPRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
The International journal of health planning and management
|September 4, 2023
概括
基于价值的支付模式旨在提高医疗保健价值,但风险选择可能导致效率低下和不平等. 有策略可以尽量减少这种情况,但问题可能会持续存在.
科学领域:
- 医疗保健经济学 医疗保健经济学
- 卫生政策分析 卫生政策分析
- 改善医疗保健的质量.
背景情况:
- 基于价值的医疗保健 (VBH) 旨在通过创新的报销策略来提高患者价值和系统效率.
- 基于价值的支付 (VBP) 模式是VBH的一个关键机制,旨在将提供者的激励措施与患者的结果和成本效益相协调.
- 然而,VBP模型可能无意中引入或加剧风险选择,这种现象会损害医疗保健的公平性和效率.
研究的目的:
- 分析基于价值的支付模式中风险选择的多方面的性质.
- 确定医疗保健中风险选择表现的潜在原因和水平.
- 建议和评估策略,以减轻风险选择在VBP的意外后果.
主要方法:
- 在VBP中对风险选择机制的概念分析.
- 审查关于VBP结果和相关偏见的现有文献.
- 探索风险减轻的政策和组织策略.
主要成果:
- 风险选择是一个复杂的问题,发生在患者,医院和系统层面.
- 原因包括绩效指标的选择偏差,偏好的患者选择和声誉因素.
- 潜在的缓解策略包括模型设计,透明报告,风险调整和全面的绩效指标.
结论:
- 虽然VBP模型提供了潜在的好处,但风险选择的持续挑战需要持续关注.
- 实施具有吸引力的,非强制性的VBP模型,强大的风险调整和扩展的绩效指标的组合至关重要.
- 持续监测和评估对于管理和最小化风险选择至关重要,尽管完全消除可能是不可行的.
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