Using Pay-For-Success To Increase Investment In The Nonmedical Determinants Of Health
Using Pay-For-Success To Increase Investment In The Nonmedical Determinants Of Health
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DOI：
10.1377/hlthaff.2014.0741
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发表时间：
2014-11-01
期刊：
影响因子：
9.7
通讯作者：
Galloway, Ian
中科院分区：
文献类型：
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作者：
Galloway, Ian
按服务付费和美国医疗保健系统对治疗现有疾病的长期承诺相结合，不鼓励在对长期健康做出最大贡献的行为、社会和环境(即非医疗)条件上的支出。为成功付费，也被称为社会影响债券，或SIB，提供了一种可能的解决方案。为成功付费的模式依赖于愿意预先为非医疗干预提供资金，同时承担干预可能无法预防未来疾病的风险的投资者。然而，如果干预成功，投资者将由预定的付款人(如公共卫生机构)全额偿还，并获得额外的投资回报，作为承担风险的奖励。正在开发成功付费试点，以减少儿童中与哮喘相关的紧急情况、不良的出生结局以及糖尿病前期向糖尿病的进展，以及其他应用。这些努力得到了公共机构数据共享和协调医疗等关键政策改革的支持，有望增加以证据为基础的非医疗服务提供者的数量，并孕育一个重视健康而不仅仅是医疗保健的新市场。
The combination of fee-for-service payments and the US health care system's standing commitment to treating existing illness discourages spending on the behavioral, social, and environmental (that is, the nonmedical) conditions that contribute most to long-term health. Pay-for-success, alternatively known as social impact bonds, or SIBs, offers a possible solution. The pay-for-success model relies on an investor that is willing to fund a nonmedical intervention up front while bearing the risk that the intervention may fail to prevent disease in the future. Should the intervention succeed, however, the investor is repaid in full by a predetermined payer (such as a public health agency) and receives an additional return on its investment as a reward for taking on the risk. Pay-for-success pilots are being developed to reduce asthma-related emergencies among children, poor birth outcomes, and the progression of prediabetes to diabetes, among other applications. These efforts, supported by key policy reforms such as public agency data sharing and coordinated care, promise to increase the number of evidence-based nonmedical service providers and seed a new market that values health, not just health care.