初级保健提供者对付费绩效计划的偏好:在中国山东的一个离散选择实验研究
Wencai Zhang1, Yanping Li2, BeiBei Yuan3
1Dong Fureng Institute of Economic and Social Development, Wuhan University, Luojia Hill, Wuhan, 430072, China.
Human resources for health
|March 13, 2024
概括
初级医疗保健提供者在绩效支付 (P4P) 计划中更喜欢奖金而不是罚款,每月支付而不是年度支付. 根据这些偏好设计P4P计划可以提高医疗保健质量.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 初级医疗保健政策 基本医疗保健政策
背景情况:
- 按绩效支付 (P4P) 计划被广泛用于提高初级医疗保健 (PHC) 质量.
- P4P的有效性取决于计划设计和提供者偏好.
- 了解这些偏好对于优化P4P在中国的实施至关重要.
研究的目的:
- 调查初级医疗保健提供者对绩效支付 (P4P) 计划的关键属性的偏好.
- 确定影响医疗保健提供者参与P4P计划的意愿因素.
- 为在中国山东省设计更有效的P4P倡议提供信息.
主要方法:
- 对882名初级医疗保健提供者进行了离散选择实验 (DCE).
- 评估了六个属性:激励类型,受益者,频率,规模,绩效领域和结果披露.
- 统计分析采用混合逻辑和潜在类模型来分析偏好.
主要成果:
- 提供者更喜欢奖金而不是罚款,更喜欢每月的奖金而不是每年的奖金.
- 对大型激励规模 (60%的收入),集团激励和不披露结果观察到负面偏好.
- 对较小的激励金额 (20%的收入) 和将护理质量纳入绩效指标中,发现了积极的偏好.
- 确定了四个不同的提供者类别,具有不同的P4P偏好.
结论:
- 包含奖金,每月支付,适度激励规模,个人奖励,质量指标和透明结果的P4P计划可能更有效.
- 承认和解决提供者偏好异质性对于成功的P4P设计至关重要.
- 根据提供者偏好调整P4P计划可以提高初级医疗保健的绩效.
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