Balancing influence between actors in healthcare decision making.
Balancing influence between actors in healthcare decision making.
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DOI：
10.1186/1472-6963-11-85
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发表时间：
2011-04-19
影响因子：
2.8
通讯作者：
Babad YM
中科院分区：
文献类型：
--
作者：
Kaplan RM;Babad YM
大多数发达国家的医疗保健成本与更好的患者和公共卫生结果没有明确联系，而是与服务提供方向有关。在美国，这导致医疗保健的可用性和使用存在很大差异，成本增加，雇主参与医疗保险计划减少，总体人口健康结果减少。最近的美国医疗保健改革立法只解决了其中的一些问题。其他国家也面临类似的医疗问题。医疗保健的一个主要目标是改善患者的健康状况。这一目标在许多国家没有实现，因为目前的激励措施和结构与最大限度地提高人口健康水平不一致。这种不一致的发生是因为医疗保健“参与者”之间的利益竞争。在一个简化的模型中，这些是有动机提高自己健康的个人;企业（包括非营利组织、营利组织和政府提供者、付款人和供应商等）受利益、政治、组织和其他力量的驱使;政府除了作为人民的代表和保护者之外，还经常扮演医疗保健支付者和提供者的冲突角色。由于相对于个人和公众而言，企业和政府行为者对资源和信息的控制，行为者之间存在着不平衡。未能采取有效的预防性干预措施也许是激励措施不协调的最好例子。我们认为，目前的帕累托有效的平衡的演员之间的帕累托边界，并表明，在医疗保健市场的重大变化，需要在公用事业的企业和政府行为者的重大变化。在现有资源的限制和目前各行为者之间的平衡的范围内，有必要采取各种行动，最大限度地提高人口健康水平。这些行动包括提高医疗决策各个方面的透明度，让患者更多地参与共同的医疗决策，加强对指南制定和覆盖决策的监督，限制直接面向消费者的广告，以及加强政府作为公众倡导者的作用。
Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision making, greater involvement of patients in shared medical decision making, greater oversight of guideline development and coverage decisions, limitations on direct to consumer advertising, and the need for an enhanced role of the government as the public advocate.
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影响因子：
16.4
作者：
KAPLAN, RM
通讯作者：
KAPLAN, RM
影响因子：
4.2
作者：
KAPLAN, RM
通讯作者：
KAPLAN, RM
影响因子：
5.5
作者：
Frosch, DL;Kaplan, RM
通讯作者：
Kaplan, RM
影响因子：
37.8
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通讯作者：
Stone, NJ
影响因子：
9.7
作者：
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通讯作者：
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