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医院自主权如何影响提供者支付改革的有效性?
Sian Hsiang-Te Tsuei1,2,3, Winnie Chi-Man Yip3
1Department of Family Practice, UBC, Vancouver, British Columbia, Canada.
概括
拥有更大的自治权的医院可能无法在提供者支付改革 (PPRs) 下提高卫生系统的效率. 对财务和设备采购的自主性与PPR反应较差,口袋支出增加有关,这表明利. 政策制定者必须在授予自治权之前考虑现有激励措施.
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
- 公共卫生政策 公共卫生政策
背景情况:
- 提供者支付改革 (PPR) 旨在提高卫生系统的效率,但结果各不相同.
- 医院的组织特点,特别是自主权,可以影响PPR实施的有效性.
- 了解医院自主性如何与PPR相互作用,对于优化医疗保健服务至关重要.
研究的目的:
- 调查医院更高的自主性是否会导致更有效地应对提供者支付改革.
- 检查医院自主权不同维度对PPRs影响的温和效应.
主要方法:
- 利用来自中国 (2014-2018) 集群随机控制PPR干预的数据.
- 干预将退款从服务费转移到新合作医疗计划 (NCMS) 的全球预算.
- 评估过剩,招聘和采购方面的自主性,将这些与差异差异估计器进行交互.
主要成果:
- 对剩余和设备采购的自主性与NCMS支出增长的增加相关,表明PPR响应较差.
- 这些自主性维度也显示出更高的自费支出趋势.
- 拥有多余自主权的医院每次入院的自费费用更高,这表明利最大化倾向.
结论:
- 增加医院自主性并不能保证对以效率为重点的PPRs的反应得到改善,特别是如果以前的激励措施鼓励利最大化.
- 政策制定者需要在实施之前评估与自治相关的潜在不良激励措施.
- 调整财政激励措施对于使医院行为与PPR目标保持一致至关重要.
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