How do healthcare providers respond to multiple funding flows? A conceptual framework and options to align them.
How do healthcare providers respond to multiple funding flows? A conceptual framework and options to align them.
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DOI：
10.1093/heapol/czab003
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发表时间：
2021-06-25
影响因子：
3.2
通讯作者：
Hanson K
中科院分区：
文献类型：
--
作者：
Barasa E;Mathauer I;Kabia E;Ezumah N;Mbau R;Honda A;Dkhimi F;Onwujekwe O;Phuong HT;Hanson K
提供者支付方法是一个关键的卫生政策杠杆，因为它们影响医疗保健提供者的行为，并影响卫生系统的目标，如效率，公平，财政保护和质量。以前的研究集中在单独分析单个供应商的支付方式，或单个购买者的行为。然而，购买者通常使用混合的提供者支付方法来支付医疗保健提供者，并且大多数卫生系统被多个购买者分割。从医疗服务提供者的角度来看，这些不同的付款是作为多个资金流来体验的，这些资金流一起发出了一组关于他们应该集中精力的复杂信号。在这篇文章中，我们认为，有必要扩大供应商的支付方式的分析，包括多个资金流的相互作用的分析和他们的激励措施对提供医疗服务的综合影响。本文的目的是强调多种资金流向卫生设施的重要性，并提出了一个概念框架，以指导其分析。该框架假设，当医疗保健提供者收到多个资金流，他们可能会发现某些资金流比其他更有利的基础上，这些资金流如何相互比较的一系列属性。这就产生了一系列激励措施，因此，医疗服务提供者可能会以三种方式改变他们的行为：资源转移、服务转移和成本转移。我们描述了这些行为以及它们如何影响卫生系统的目标。我们的分析强调，需要调整多种资金流动产生的激励措施。为了实现这一目标，我们提出了与医疗保健采购治理相关的三项政策策略：减少医疗融资安排的碎片化，以减少多个购买者安排和资金流动的数量;协调多个资金流动的信号;限制提供者对不良激励措施做出反应。
Provider payment methods are a key health policy lever because they influence healthcare provider behaviour and affect health system objectives, such as efficiency, equity, financial protection and quality. Previous research focused on analysing individual provider payment methods in isolation, or on the actions of individual purchasers. However, purchasers typically use a mix of provider payment methods to pay healthcare providers and most health systems are fragmented with multiple purchasers. From a health provider perspective, these different payments are experienced as multiple funding flows which together send a complex set of signals about where they should focus their effort. In this article, we argue that there is a need to expand the analysis of provider payment methods to include an analysis of the interactions of multiple funding flows and the combined effect of their incentives on the provision of healthcare services. The purpose of the article is to highlight the importance of multiple funding flows to health facilities and present a conceptual framework to guide their analysis. The framework hypothesizes that when healthcare providers receive multiple funding flows, they may find certain funding flows more favourable than others based on how these funding flows compare to each other on a range of attributes. This creates a set of incentives, and consequently, healthcare providers may alter their behaviour in three ways: resource shifting, service shifting and cost shifting. We describe these behaviours and how they may affect health system objectives. Our analysis underlines the need to align the incentives generated by multiple funding flows. To achieve this, we propose three policy strategies that relate to the governance of healthcare purchasing: reducing the fragmentation of health financing arrangements to decrease the number of multiple purchaser arrangements and funding flows; harmonizing signals from multiple funding flows; and constraining providers from responding to undesirable incentives.
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影响因子：
11.1
作者：
Mathauer, Inke;Torres, Lluis Vinyals;Hanson, Kara
通讯作者：
Hanson, Kara
DOI：
10.1002/hpm.4740100104
发表时间：
1995-01-01
影响因子：
2.7
作者：
BARNUM, H;KUTZIN, J;SAXENIAN, H
通讯作者：
SAXENIAN, H
DOI：
10.1002/hpm.2565
发表时间：
2018-10
期刊：
The International journal of health planning and management
影响因子：
--
作者：
Kazungu JS;Barasa EW;Obadha M;Chuma J
通讯作者：
Chuma J
影响因子：
4.8
作者：
Mbau, Rahab;Kabia, Evelyn;Barasa, Edwine
通讯作者：
Barasa, Edwine
影响因子：
3.7
作者：
Patcharanarumol, Walaiporn;Panichkriangkrai, Warisa;Tangcharoensathien, Viroj
通讯作者：
Tangcharoensathien, Viroj