Waste in the U. S. Health Care System: A Conceptual Framework
Waste in the U. S. Health Care System: A Conceptual Framework
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DOI：
10.1111/j.1468-0009.2008.00537.x
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发表时间：
2008-12-01
影响因子：
6.6
通讯作者：
Keeler, Emmett B.
中科院分区：
文献类型：
--
作者：
Bentley, Tanya G. K.;Effros, Rachel M.;Keeler, Emmett B.
背景：美国的卫生保健费用远高于那些卫生系统性能相似或更好的工业国家。浪费性开支会产生许多不良后果，这些后果可以通过减少浪费来缓解。本文提出了一个概念框架，以指导研究人员和政策制定者评估废物，实施减少废物战略，并减少不必要的卫生保健支出的负担。方法：本文将卫生保健废物分为行政废物、业务废物和医疗废物，并对每一种废物进行概述。它解释了研究人员如何使用高层次和特定部门或程序的比较来量化此类废物，并讨论了废物测量和减少废物方面的例子和挑战。结果：浪费是由健康保险和医疗不确定性等因素造成的，这些因素鼓励生产效率低下和低价值的服务。减少此类浪费的各种努力都遇到了挑战，例如初始投资成本高、意外的管理复杂性以及患者、付款人和提供者利益之间的权衡。虽然对废物进行分类可能有助于确定和衡量废物的一般类型和来源，但成功的减少战略必须结合护理的行政、业务和临床组成部分，并通过确定目标、改变系统激励措施和改进具体程序来进行。结论：分类、识别和测量浪费阐明了其原因，明确了系统目标，并明确了潜在的医疗改革——通过改善医疗保险和医疗保健市场——将产生提高效率的激励，从而最终减少美国医疗保健系统的浪费。
Context: Health care costs in the United States are much higher than those in industrial countries with similar or better health system performance. Wasteful spending has many undesirable consequences that could be alleviated through waste reduction. This article proposes a conceptual framework to guide researchers and policymakers in evaluating waste, implementing waste-reduction strategies, and reducing the burden of unnecessary health care spending.Methods: This article divides health care waste into administrative, operational, and clinical waste and provides an overview of each. It explains how researchers have used both high-level and sector- or procedure-specific comparisons to quantify such waste, and it discusses examples and challenges in both waste measurement and waste reduction.Findings: Waste is caused by factors such as health insurance and medical uncertainties that encourage the production of inefficient and low-value services. Various efforts to reduce such waste have encountered challenges, such as the high costs of initial investment, unintended administrative complexities, and trade-offs among patients', payers', and providers' interests. While categorizing waste may help identify and measure general types and sources of waste, successful reduction strategies must integrate the administrative, operational, and clinical components of care, and proceed by identifying goals, changing systemic incentives, and making specific process improvements.Conclusions: Classifying, identifying, and measuring waste elucidate its causes, clarify systemic goals, and specify potential health care reforms that-by improving the market for health insurance and health care-will generate incentives for better efficiency and thus ultimately decrease waste in the U.S. health care system.