为优质慢性护理购买初级保健服务:在四个国家与绩效支付相匹配
Sarah L Barber1, Inke Mathauer2, Megumi Rosenberg1
1Centre for Health Development, World Health Organization, Kobe, Japan.
概括
智利,中国,印度尼西亚和南非的慢性病护理支付改革由于设计和实施的挑战,造成的影响不足. 调整质量指标以适应患者风险,并使用渐进式目标,对于改善医疗保健质量至关重要.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 非传染性疾病管理
背景情况:
- 改善慢性病的护理质量对于减少非传染性疾病的过早死亡率至关重要.
- 正在探索医疗保健采购安排,以提高服务提供和结果.
研究的目的:
- 介绍关于医疗保健采购安排的案例研究的结果,使用与绩效支付的资本化.
- 评估这些支付方式对服务质量和慢性疾病的健康结果的影响.
主要方法:
- 智利,中国,印度尼西亚和南非的初级保健提供者的案例研究.
- 实施带有绩效报酬的资本化,并支持诸如培训和非财务激励等干预措施.
主要成果:
- 激励措施不足以推动供应商对质量改善的显著行为变化.
- 设计和实施的挑战 (例如,自愿招生,质量指标,风险调整,付款确定性) 导致患者数量和吸收率较低,降低了预期的影响.
- 支付时间/水平的不确定性和扣留支付可能会破坏影响.
结论:
- 根据患者健康风险和复杂性调整质量指标至关重要,以避免惩罚提供者.
- 相对或渐进的质量目标可能更适合不同的供应商能力和国家计划.
- 解决设计和实施的挑战对于慢性病护理的有效支付改革至关重要.
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