The promise and peril of health systems.
The promise and peril of health systems.
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DOI：
10.1111/1475-6773.13595
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发表时间：
2020-12
影响因子：
3.4
通讯作者：
Kronick R
中科院分区：
文献类型：
--
作者：
Kronick R
2013年，在我有幸成为美国医疗保健研究和质量局（AHRQ）局长后不久，我说我已经无数次听说盖辛格卫生系统是美国表现最好的医疗保健系统之一。我说我完全愿意相信，但我没有办法确定。即使我拥有AHRQ的资源，即使我做了近40年的卫生服务研究员，我也不能说盖辛格比下一个卫生系统更好还是更差。美国的医疗保健越来越多地由隶属于卫生系统的医生和医院提供，但我们对这些卫生系统的表现知之甚少，更不知道如何促进绩效改善。本卷中的论文，作为AHRQ比较卫生系统绩效倡议的一部分，扩展了我们的知识。出现的是一幅越来越被大型系统主导的医疗保健图景。在明智的政策指导下，这可能是一个非常好的消息：大型卫生系统有潜力提高公平性、质量和效率。否则，卫生系统的崛起可能会带来麻烦：它们可能会使医疗保健更加昂贵，质量更低，对病人的反应更少。在这篇评论中，我描述了卫生系统的前景和危险，强调了本书中引人注目的发现，并提出了两项政策建议。
Soon after I had the privilege of becoming Director of the Agency for Healthcare Research and Quality (AHRQ), in 2013, I remarked that I had heard innumerable times that Geisinger Health System was one of the highest performing health care systems in the United States. I said that I was perfectly willing to believe it, but that I had no way of knowing for sure. Even with AHRQ’s resources at my fingertips, and even after nearly four decades as a health services researcher, I could not say whether Geisinger was better or worse than the next health system.My ignorance about Geisinger's performance was emblematic of a broader problem. Health care in the United States is increasingly being delivered by physicians and hospitals that are affiliated with health systems, yet we know very little about how these health systems perform, and even less about how to foster performance improvement. The papers in this volume, written as part of the AHRQ Comparative Health System Performance initiative, expand our knowledge. What emerges is a picture of a health care landscape increasingly dominated by large systems. Guided by smart policy, that could be very good news: Large health systems have the potential to improve equity, quality, and efficiency. Otherwise, the rise of health systems could spell trouble: They could make health care more expensive, lower quality, and be less responsive to patients. In this commentary, I describe the promise and peril of health systems, highlight striking findings from this volume, and conclude with two policy recommendations.
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