超越演示:在医疗保险中实施初级保健混合支付模式
Robert A Berenson1, Adele Shartzer1, Hoangmai H Pham2
1Urban Institute Health Policy Center, Washington, DC 20034, United States.
Health affairs scholar
|May 17, 2024
概括
初级保健支付改革需要一种混合模式,将服务费和基于人口的支付混合在一起. 这种方法支持实践转型和初级保健.
科学领域:
- 卫生政策和管理卫生政策和管理
- 提供初级保健服务的模式.
- 医疗保健支付改革 医疗保健支付改革
背景情况:
- 美国国家科学,工程和医学院 (NASEM) 2021年报告建议在初级保健方面采用混合支付模式.
- 目前的初级保健支付结构需要改革,以支持实践转型和初级保健的不断变化的作用.
- 现有的医疗保险医生费用表需要大幅调整,以充分补偿初级保健服务.
研究的目的:
- 为NASEM的初级保健支付建议提出务实的实施策略.
- 解决并为采用混合支付模式的关键挑战提供解决方案.
- 倡导立即在医疗保险中采用混合支付,绕过进一步的示范.
主要方法:
- 对混合初级保健支付模式的实施挑战的分析.
- 探索50:50的服务费和基于人口的支付混合.
- 根据初级保健控制的利用措施,提出支出问责制的建议.
- 开发一种新的质量测量方法,强调节和结果重点.
主要成果:
- 一种混合支付模式,具有平衡的服务费和基于人口的组件,被认为是初级保健转型的关键.
- 支出问责制应该优先考虑初级保健控制中的利用指标,而不是护理总成本.
- 质量测量应该简化,专注于具有改善潜力的显著结果.
结论:
- 尽管存在实施障碍,但在医疗保险中迫切需要采用混合支付模式.
- 拟议的混合模式为支持和增强初级保健服务提供了一条可行的途径.
- 改革质量指标和基于利用的支出问责制是成功进行初级保健支付改革的关键组成部分.
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