[1]孙 辉,王海银,谢春艳,等.美国以价值为导向的医保支付模式应用及启示[J].卫生经济研究,2020,(06):24-27.
 SUN Hui,WANG Hai-yin,XIE Chun-yan,et al.Application and Enlightenment of Value-oriented Medical Insurance Payment Model in the United States[J].Journal Press of Health Economics Research,2020,(06):24-27.
点击复制

美国以价值为导向的医保支付模式应用及启示

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
期数:
2020年06期
页码:
24-27
栏目:
医保天地
出版日期:
2020-06-04

文章信息/Info

Title:
Application and Enlightenment of Value-oriented Medical Insurance Payment Model in the United States
作者:
孙 辉1王海银1谢春艳1金春林1
1. 上海市卫生和健康发展研究中心(上海市医学科学技术情报研究所), 上海 200040
Author(s):
SUN HuiWANG Hai-yinXIE Chun-yanJIN Chun-lin
Shanghai Health and Health Development Research Center (Shanghai Institute of Medical Science and Technology Information),Shanghai 200040,China
关键词:
价值导向 医保支付方式美国
Keywords:
value orientationmedical insurance payment methodsUnited States
分类号:
F840.684
文献标志码:
A
摘要:
通过文献复习,梳理了美国按绩效支付、捆绑支付、共享结余与风险分担支付等以价值为导向的医保支付模式,总结其模式设计、运作形式、实施效果、潜在问题等,提出对我国医保支付方式改革的启示:政府推动,加快试点;有效利用卫生技术评估决策支持工具;强化健康监测,加强疾病预防干预。
Abstract:
After reviewing the literature,it summarized the value-oriented medical insurance payment models in the United States such as performance-based payments,bundled payments,shared balances,and risk-sharing payments. It summarized the model design,operation forms,implementation effects,and potential problems of these models,and proposed mode reform of medical insurance payment in China: governmental promotion of the pilot;effective use of health technology assessment decision-making support tools;strengthening health surveillance and disease prevention and intervention.

参考文献/References:

[1] 王思敏,徐伟,崔子丹,等.价值医疗导向的医保支付方式初探 ——以中美典型按价值付费项目为例[J].卫生经济研究,2019,36(2):9-12.
[2] EPSTEIN AM,LEE TH,HAMEL MB.Paying physicians for high-quality care[J].N Engl J Med,2004,350:406-410.
[3] 袁蓓蓓,何莉,孟庆跃,等.按绩效支付方式对门诊服务机构绩效的效果评价[J].中国卫生政策研究,2017,10(9):8-21.
[4] 刘心怡, 张璐莹,陈文.医疗保险按绩效支付及其效果的研究综述[J].中国卫生事业管理,2019,36(3):180-182,214.
[5] SWOL MA.Does pay-for-performance improve the quality of health care?ANN INTERN MED,2007,146:538,538-539.
[6] ZUCJERMAN RB,SHEINGOLD SH,ORAV EJ,et al.Readmissions,observation, and the Hospital Readmissions Reduction Program[J].N Engl J Med,2016,374:1543-551.
[7] KRUSE GR,CHANG Y,KELLEY JH,et al.Healthcare system effects of pay-for-performance for smoking status documentation[J].Am J Manag Care,2013,19:554-561.
[8] LEMAK CH,NAHRA TA,COHEN GR, et al. Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care[J].Health Affairs,2015, 34:645-652.
[9] NEJM Catalyst. What Are Bundled Payments?[EB/OL].[2018-02-28].https://catalyst.nejm.org/what-are-bundled-payments.
[10] Centers for Medicare & Medicaid Servces. Bundled payments for care improvement (BPCI) initiative: general information[EB/OL].[2018-10-11].https://innovation.cms.gov/initiatives/ bundled-payments.
[11] NAVATHE AS,TROXEL AB,LIAO JM,et al. Cost of Joint Replacement Using Bundled Payment Models[J].JAMA Intern Med,2017,177(2):214-222.
[12] 吴伟旋, 向前. 捆绑支付对我国医疗卫生领域供给侧改革的启示[J].中国卫生经济,2017,36(7):22-24.
[13] HUSSEY PS,EIBNER C,RIDGELY MS,et al. Controlling U.S. health care spending-separating promising from unpromising approaches[J]. N Engl J Med,2009,361(22):2109-2111.
[14] PORTER ME,KAPLAN RS. How to pay for health care[J]. Harvard business review,2016,94(7-8):88-98,100,134.
[15] 龚秀全,周薇.基于竞争的合作:美国责任制医疗组织发展中的利益协调与启示[J].中国卫生政策研究,2018(3):29-36.
[16] American College of Physician. Detailed Summary-Medicare Shared Savings/Accountable Care Organization(ACO) Program [EB/OL].[2014-09-03]. http://www.acponline.org.
[17] 朱晓丽.美国基于整合医疗服务的医保支付方式改革经验及启示[J].中国物价,2019(1):89-91.
[18] US Department of Health & Human Services. Medicare Shared Savings Program Accountable Care Organizations Have Shown Potential for Reducing Spending and Improving Quality[EB/OL].[2017-08-28] .https://oig.hhs.gov/oei/reports/oei-02-15-00450.asp.
[19] FRIEDBERG MW,ROSENTHAL MB, WERNER RM. Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care[J].JAMA Intern Med,2015,175.
[20] 张朝阳,潘伟,朱坤,等.医保支付方式改革实践与启示——基于卫十一项目探索[J].中国卫生政策研究,2017,10(9):1-7.

更新日期/Last Update: 2020-06-04