Selection incentives in a performance-based contracting system
Selection incentives in a performance-based contracting system
复制标题
DOI：
10.1111/1475-6773.00132
复制
发表时间：
2003-04-01
影响因子：
3.4
通讯作者：
Shen, YJ
中科院分区：
文献类型：
--
作者：
Shen, YJ
Objective.调查基于绩效的合同（PBC）系统是否为非营利的药物滥用治疗提供者提供激励，以选择不太严重的客户进行治疗。缅因州成瘾治疗系统（MATS）标准化的入院和出院数据提供的缅因州办公室的物质滥用（OSA）的财政年度1991-1995年，提供人口统计学，物质滥用，和社会功能的信息接受公共funding.Study设计。我们专注于OSA客户（即，那些治疗费用由OSA的资金支付的患者）和门诊计划中的医疗补助客户。客户被确定为“最严重”或不是。我们比较了阻塞性睡眠呼吸暂停患者在PBC前和PBC后成为“最严重”的可能性，并以医疗补助患者作为对照。采用多元回归分析预测PBC对OSA患者在控制其他因素后最严重的概率的边际效应。在基于绩效的合同创新之后，被归类为最严重用户的OSA门诊客户的百分比下降了7%（p< = 0.001），而医疗补助客户的百分比则增加了2%。回归结果还显示PBC对OSA患者最严重的概率有显著的负向边际效应。基于绩效的合同给予药物滥用治疗提供者经济激励，以治疗不太严重的OSA客户，以改善他们的绩效结果。实施PBC后，在门诊治疗的严重程度最高的OSA患者减少。这些结果表明，监管机构，或付款人，应全面评估计划考虑到这种类型的选择行为。
Objective. To investigate whether a performance-based contracting (PBC) system provides incentives for nonprofit providers of substance abuse treatment to select less severe clients into treatment.Data Sources. The Maine Addiction Treatment System (MATS) standardized admission and discharge data provided by the Maine Office of Substance Abuse (OSA) for fiscal years 1991-1995, provides demographic, substance abuse, and social functional information on clients of programs receiving public funding.Study Design. We focused on OSA clients (i.e., those patients whose treatment cost was covered by the funding from OSA) and Medicaid clients in outpatient programs. Clients were identified as being "most severe" or not. We compared the likelihood for OSA clients to be "most severe" before PBC and after PBC using Medicaid clients as the control. Multivariate regression analysis was employed to predict the marginal effect of PBC on the probability of OSA clients being most severe after controlling for other factors.Principal Findings. The percentage of OSA outpatient clients classified as most severe users dropped by 7 percent (p< = 0.001) after the innovation of performance-based contracting, compared to the increase of 2 percent for Medicaid clients. The regression results also showed that PBC had a significantly negative marginal effect on the probability of OSA clients being most severe.Conclusions. Performance-based contracting gave providers of substance abuse treatment financial incentives to treat less severe OSA clients in order to improve their performance outcomes. Fewer OSA clients with the greatest severity were treated in outpatient programs with the implementation of PBC. These results suggest that regulators, or payers, should evaluate programs comprehensively taking this type of selection behavior into consideration.