Modeling and designing health care payment innovations for medical imaging
Modeling and designing health care payment innovations for medical imaging
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医学成像的医疗保健支付创新建模和设计
DOI：
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发表时间：
2016
影响因子：
3.6
通讯作者：
D. Hughes
中科院分区：
文献类型：
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作者：
Hui Zhang;Christian Wernz;D. Hughes
更好地协调医疗保健激励措施的支付创新是降低医疗保健成本和提高医疗质量的一种有前途的方法。然而，设计有效的支付系统是具有挑战性的，因为医疗保健系统具有许多利益相关者的复杂性，而且他们的目标往往相互冲突。缺乏能够全面捕捉和有效分析复杂的、多层次的相互作用，从而预测新的支付系统对利益攸关方决策和全系统结果的影响的数学模型。为了解决多层次卫生保健模型的需求，我们应用了多尺度决策理论(MSDT)，并建立在其最新进展的基础上。在本文中，我们专门研究面向责任关怀组织(ACO)的联邦医疗保险共享储蓄计划(MSSP)，并确定该激励计划如何影响计算机断层扫描(CT)的使用，以及如何对其进行重新设计以最大限度地减少不必要的CT扫描。该模型捕捉了关键利益相关者，即付款人、ACO、医院、初级保健医生、放射科医生和患者的多层次交互、决策和结果。对它们相互依赖的决策进行博弈分析，得出了代表利益相关者规范性决策反应的均衡解。我们的结果为支付者如何改善MSSP提供了决策见解，为ACO如何在其成员中分配MSSP奖励提供了决策见解，并为医院是否投资于新的CT成像系统提供了决策见解。
Payment innovations that better align incentives in health care are a promising approach to reduce health care costs and improve quality of care. Designing effective payment systems, however, is challenging due to the complexity of the health care system with its many stakeholders and their often conflicting objectives. There is a lack of mathematical models that can comprehensively capture and efficiently analyze the complex, multi-level interactions and thereby predict the effect of new payment systems on stakeholder decisions and system-wide outcomes. To address the need for multi-level health care models, we apply multiscale decision theory (MSDT) and build upon its recent advances. In this paper, we specifically study the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs) and determine how this incentive program affects computed tomography (CT) use, and how it could be redesigned to minimize unnecessary CT scans. The model captures the multi-level interactions, decisions and outcomes for the key stakeholders, i.e., the payer, ACO, hospital, primary care physicians, radiologists and patients. Their interdependent decisions are analyzed game theoretically, and equilibrium solutions - which represent stakeholders’ normative decision responses - are derived. Our results provide decision-making insights for the payer on how to improve MSSP, for ACOs on how to distribute MSSP incentives among their members, and for hospitals on whether to invest in new CT imaging systems.
影响因子：
9.7
作者：
Douven, Rudy;McGuire, Thomas G.;McWilliams, J. Michael
通讯作者：
McWilliams, J. Michael