从医疗保险公司的角度看,将医疗从医院转移到全科医院:一项采访研究
Jesper T Dros1,2,3, Isabelle Bos4, Christel E van Dijk5
1Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands. j.t.dros@tilburguniversity.edu.
BMC health services research
|November 21, 2025
概括
荷兰医疗保险公司认为,长期合同和强有力的一般做法是将医疗从医院转移关键. 然而,监管不确定性,补偿不足和医院的谈判权阻碍了这一转型,需要政策调整以实现有效的替代.
科学领域:
- 医疗保健政策和经济学
- 主要护理转型的转变.
- 医疗保险市场动态 医疗保险市场动态
背景情况:
- 政策制定者旨在通过将医疗保健从医院转移到初级保健机构来降低医疗保健成本并改善医疗保健的获取.
- 医疗保险公司对护理替代计划的成功有很大的影响.
- 本研究探讨了荷兰医疗保险公司对将护理从医院转移到全科医院的障碍和促进者的观点.
研究的目的:
- 探讨荷兰医疗保险公司关于将医院护理替换为全科医院护理的障碍和推动因素的观点.
- 从付款人的角度确定影响荷兰医疗保健系统内医疗保健服务转型的关键因素.
主要方法:
- 与来自荷兰七家主要医疗保险公司的15名医疗保健购买者进行了半结构化的小组访谈.
- 应用了主题分析,以确定与辅助者和护理替代障碍相关的反复出现的主题.
主要成果:
- 促进者包括战略规划的长期合同,强大的全科医院组织结构和延长的医院等待时间.
- 发现的障碍包括"竞争法"规定的合作不确定性,不充分的风险均等补偿,复杂的创新计费,国家预算的刚性和医院强大的谈判权力.
结论:
- 建议包括更明确的保险公司合作指南,风险均等模式调整,增强通用实践的谈判权,以及促进长期合同.
- 解决已识别的障碍对于成功的医院到全科医院的护理替代至关重要.
- 需要改善政策制定者和医疗保险公司之间的对话,以使观念和法规保持一致.
更多相关视频
05:04Author Spotlight: Evaluating Clinicians' Adoption of Ultrasound-Guided Vascular Cannulation Through Simulation Training
Published on: August 9, 2024
1.4K
07:31Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
7.5K
相关概念视频
01:18Introduction To Health Care Delivery System
3.7K
The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
3.7K
01:26Methods Of Healthcare Delivery System
3.9K
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
3.9K
01:29Issues And Trends In Healthcare Delivery System
6.1K
The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
6.1K
01:30Primary Healthcare Services
1.9K
Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of healthcare include physician offices, public health clinics, school nursing, and community health nursing.
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
1.9K
01:11Secondary Healthcare System
1.9K
Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
1.9K
01:29Documentation in Long-Term and Home Healthcare Setting
1.4K
Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
Long-Term Care Facilities
Long-Term Care Facilities
1.4K