激励维护:在瘤学价值支付改革期间,分级机构工作
Thomas Reindersma1, Isabelle Fabbricotti1, Kees Ahaus1
1Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands.
Social science & medicine (1982)
|March 27, 2024
概括
由于现有的做法,医疗保健专业人员经常抵制基于价值的支付改革. 这项研究揭示了医生和销售部门等各种参与者如何维持现状,阻碍支付改革的采用.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 组织行为 组织行为
- 医疗保健管理的管理
背景情况:
- 基于价值的支付模式旨在通过从量驱动的报销转变来提高医疗保健质量和效率.
- 之前的研究强调了采用新支付模式的供应商挑战,但参与者的动机仍未得到充分探索.
研究的目的:
- 调查非临床和临床专业人员维持传统支付实践的动机,尽管有基于价值的支付改革.
- 了解不同参与者在医院环境中采用或拒绝基于价值的支付计划中的作用.
主要方法:
- 在一家荷兰医院联盟中进行了一项案例研究,该联盟为前列腺癌护理实施了基于价值的支付.
- 数据收集包括观察和采访各种医院人员,包括销售部门,医疗专业企业 (MSE) 和医生.
主要成果:
- 各级参与者表现出维持现有支付实践的动机.
- 在销售经理中,监管动机很突出,而医生则表现出文化认知和规范动机.
- 一个关键的动机是,人们相信,在当前的系统中,可以实现所需的护理途径创新,从而减少对支付改革的感知需求.
结论:
- 医疗保健参与者参与机构维护工作,影响基于价值的支付改革的成功.
- 依赖关系,特别是医生对中小企业和销售部门的依赖,将这些群体定位为守门员,显著影响改革的采用.
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