The effect of payment method and multimorbidity on health and healthcare utilisation
The effect of payment method and multimorbidity on health and healthcare utilisation
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DOI：
10.1108/jhom-05-2020-0208
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发表时间：
2021-01-07
影响因子：
1.4
通讯作者：
Sutton, Matt
中科院分区：
文献类型：
--
作者：
Hayes, Helen;Stokes, Jonathan;Sutton, Matt
目的为了鼓励对多发病患者进行更好、更综合的护理，欧洲各国已经引入了三种支付方法：按绩效支付、按协调支付和包罗万象的支付方法。我们检查这些支付方法对多发病患者的健康和医疗保健使用的影响方式是否存在差异。设计/方法/方法利用来自20个欧洲国家的个人调查数据，我们通过各国是否采用新的综合护理支付方法来检查2011-2015年平均结果的未调整差异。然后，我们使用线性、个体随机效应回归，包括国家和时间固定效应，以及在国家水平上聚集标准误差，来测试多病患者的差异效应。结果我们发现，尽管许多政策文件中存在理论预测和修辞，但不同的支付方式对多病患者的关键结果几乎没有影响。研究限制/影响政策制定者应记住，支付方法的成功取决于激励措施的具体设计及其实施。新的有效的护理模式以及如何激励多病患者的护理是一个正在进行的研究重点。原创性/价值这篇论文首次研究了整合支付对这些计划打算影响的维度和人群的影响；多病患者在个人层面的健康和医疗保健使用。
Purpose Three types of payment methods have been introduced across European countries in attempts to encourage better, more integrated care of persons with multimorbidity: pay-for-performance; pay-for-coordination; and an all-inclusive payment method. We examine whether there are differences in the way these payment methods affect health and healthcare use in persons with multimorbidity. Design/methodology/approach Using individual-level survey data from twenty European countries, we examine unadjusted differences in average outcomes for the years 2011-2015 by whether countries adopted new payment methods for integrated care. We then test for a differential effect for multimorbid persons using linear, individual random effects regressions, including country and time fixed effects and clustering standard errors at the country level. Findings We find little effect of varying payment methods on key outcomes for multimorbid individuals despite the theoretical predictions and the rhetoric in many policy documents. Research limitations/implications Policymakers should bear in mind that the success of the payment method relies on the specific design of the incentives and their implementation. New effective models of care and how to incentivise these for multimorbid patients is an ongoing research priority. Originality/value This paper is the first to study the effects of payments for integration on the dimensions and populations these schemes intend to affect; health and healthcare use at the individual level for multimorbid individuals.