Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care.
Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care.
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DOI：
10.1007/s11606-006-0083-2
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发表时间：
2007-03
影响因子：
5.7
通讯作者：
Gardner, Laurence B.
中科院分区：
文献类型：
--
作者：
Goroll, Allan H.;Berenson, Robert A.;Schoenbaum, Stephen C.;Gardner, Laurence B.
关键词：
初级保健对于保健提供系统的有效和高效运作至关重要，但该领域即将出现危机，部分原因是支付系统功能失调。我们提出了一种全新的初级保健支付模式，以全面支付全面护理取代基于医生的报销。与以前的初级保健按人头付费（简单地捆绑不充分的按服务付费）不同，我们的综合支付模式代表了对成人初级保健的新投资，在目前的水平上大幅增加了支付。全面支付针对的做法包括支持现代系统和团队，这些系统和团队对提供全面、协调的护理至关重要。初级医生的收入随着预期的高度责任而相应增加。为确保资源的最佳分配和预期成果的回报，综合付款是根据需求/风险调整的，并以业绩为基础。我们的模式与初级保健社区建立了新的社会契约，大幅增加支付，以换取实现重要的社会卫生系统目标，包括改善可及性，质量，安全和效率。这些目标的实现应有助于抵消和证明投资的成本。迫切需要对这种和其他新的初级保健支付模式进行实地测试。
Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed.
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