医院的目标设定,反和流程标准化能力如何影响提供者支付改革?
Sian Hsiang-Te Tsuei1, Winnie Chi-Man Yip2
1Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Family Practice, UBC, Vancouver, BC, Canada; Faculty of Health Sciences, SFU, Vancouver, BC, Canada.
Social science & medicine (1982)
|February 28, 2025
概括
医院管理能力影响提供者支付改革 (PPRs). 目标设定和反是适应PPR的关键,影响医疗保健成本和患者自付费用. 有效的管理提高了PPR的成功.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保健管理的管理
- 卫生经济学 卫生经济学
背景情况:
- 提供者支付改革 (PPR) 旨在提高医疗保健效率,但结果各不相同.
- 组织因素,特别是医院管理能力,调解PPRs的有效性.
- 医院设定明确目标,提供反和标准化流程的能力对于适应PPR至关重要.
研究的目的:
- 检查医院管理能力与提供者支付改革的有效性之间的关联.
- 研究具体的管理特征 (目标设定,反,标准化) 如何影响改革成果.
- 了解管理能力对保险和自费支出的影响.
主要方法:
- 一个匹配的对,集群随机对照试验的PPR在一个低收入的中国省 (2014-2018).
- 通过世界管理调查评估52家医院在目标设定,反和流程标准化方面的基线能力.
- 使用差异差异估计来分析管理特征如何改变对支出的治疗效应.
主要成果:
- 虽然个别的管理特征显示与较低的新合作医疗计划 (NCMS) 支出增长没有显著的关联,但它们的综合效应是显著的.
- 目标的具体性和反能力是对NCMS支出所观察到的影响的主要贡献者.
- 流程标准化扩大了开支转移到自己的口袋 (OOP) 来源,而目标难度有助于控制OOP支出增长.
结论:
- 医院管理能力,特别是在实现目标方面,大大降低了医疗服务提供者支付改革的有效性.
- 未来的研究应该进一步探索影响PPR结果的组织特征.
- 政策制定者和医院领导人应该促进目标制定和反机制的最佳实践,并考虑对支出转移的处罚.
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