时间就是金钱:全科医生对收费服务制度的思考
Kristian B Kraft1,2, Eivor H Hoff3,4,5, Magne Nylenna6
1Cluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway. kristianbandlien.kraft@fhi.no.
BMC health services research
|April 15, 2024
概括
挪威的全科医生 (GPs) 知道服务费支付可以影响决策,可能导致访问时间缩短和服务提供量增加. 时间压力也可能影响守门员的选择.
科学领域:
- 卫生经济学 卫生经济学
- 主要医疗保健是主要的医疗保健.
- 一般的做法一般的做法
背景情况:
- 服务费 (Fee-for-service,简称FFS) 是经合组织国家 (包括挪威) 的全科医生普遍采用的支付模式,占全科医生收入的三分之二.
- FFS系统通常会激励高服务量和短咨询时间,影响医生行为和患者获得护理.
- 一般医生作为各种服务的守门员,包括药物,转诊和病假证书,使他们的决策过程对医疗保健系统的效率至关重要.
研究的目的:
- 探讨一般医生 (GPs) 对挪威服务费 (FFS) 制度的看法.
- 调查FFS对全科医生的门决策和临床实践的潜在影响.
- 了解全科医生对财务激励的认识及其对患者管理的影响.
主要方法:
- 在2022年期间,与挪威的33名全科医生 (GP) 进行了6次焦点小组采访.
- 用专题分析来分析从重点小组收集的定性数据.
- 这项研究重点关注一般医生对服务费支付模式的反思和看法.
主要成果:
- 一般医生认识到FFS系统中的财务激励,并讨论了最大限度地增加收入的策略,例如更短的咨询.
- 参与者承认,FFS费用可能会影响他们的行为,但并不总是直接决定关门决策.
- 与拒绝患者请求相关的时间限制被确定为促进批准患者请求的因素,即使可能是不合理的,由于FFS的效率激励.
结论:
- 一般医生了解FFS系统中的财务驱动因素,并意识到其对其决策过程的潜在影响.
- 难以准确地记住和解释复杂的FFS代码的挑战可能会影响准确的计费和潜在的临床判断.
- FFS模型可能会无意中鼓励更短的咨询,可能会限制全科医生能够彻底评估和拒绝不必要的治疗的时间,从而影响门的有效性.
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