在荷兰初级保健中引入基于人口的支付模式后,支出,质量指标和提供者经验的变化:混合方法评估
Tadjo Gigengack1,2, Daniëlle Cattel3,4, Frank Eijkenaar3,4
1Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. gigengack@eshpm.eur.nl.
概括
全方位合同 (AIC) 是全科医生 (GPs) 基于人口的支付模式,在最初的2.5年里,它对医疗保健总支出没有显著影响. 虽然提供者体验有所改善,但质量指标和患者满意度显示出不同的结果.
科学领域:
- 卫生经济学 卫生经济学
- 主要护理政策的第一阶段.
- 医疗保健管理的管理
背景情况:
- 全员合同 (All-In Contract,简称AIC) 是一种基于人口的支付模式,于2017年7月为荷兰的全科医生 (GPs) 实施.
- 这种模式涉及每个患者的资本化支付,涵盖所有全科医生和多学科慢性护理,与与质量目标相关的共享节省/损失.
研究的目的:
- 调查AIC对医疗保健支出,质量指标和提供者经验在实施后2.5年的影响.
- 评估基于人口的支付模式在初级保健中的有效性.
主要方法:
- 使用差异差异方法来比较AIC入学者 (N=16,425) 和对照组 (N=212,251) 之间的个人级索赔支出.
- 前后分析检查了慢性护理管理和患者满意度指标的变化.
- 与利益相关者聚焦小组探讨了供应商的经验和上下文化的发现.
主要成果:
- AIC与每个入学者的平均季度总支出减少1.2%无关紧要 (p=0.476).
- 观察到初级保健支出增长显著下降10.2% (p<0.01),可能与资本支付索引率有关.
- 患者满意度和慢性护理管理指标显示混合和适度变化,由于数据限制,归因于AIC是不确定的. 焦点小组报告说,提供商的灵活性,自主性有所提高,管理负担减少.
结论:
- 在最初的2.5年里,AIC并没有显著影响医疗保健总支出增长.
- 质量指标在患者满意度和慢性护理管理方面呈现混合结果,而提供者经验显示有所改善.
- 加强数据收集策略对于全面评估基于人口的支付改革对人口健康,患者体验和提供者福祉的影响至关重要.
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