美国责任保健组织的发展及启示

The development of Accountable Care Organizations in the US and its implications for China

为提高卫生服务的质量和效率,美国在可支付保健法案框架下探索建立责任保健组织。本文综述了美国在建立责任保健组织过程中,卫生服务体系的整合形式、支付方式改革等主要做法,在保证医疗服务的连续性、实现资源和信息共享、促使供方主动参与、加强对医生管制等方面积累了经验,但发展责任保健组织也面临一些挑战,在机构规模、支付方式改革的全面推进、潜在垄断、患者归属和信息共享等方面存在一定问题。最后提出,在我国卫生服务体系整合的过程中,要使医疗服务机构成为整合主体和核心,建立相应的激励机制,平衡费用、质量和效率之间的关系,防止出现供方垄断,以及建立完善的信息系统等。

In order to improve the quality and efficiency of health service,Accountable Care Organization was emerged under the framework of Patient Protection and Affordable Care Act in the United States. This paper reviewed the characteristics of health delivery integration and payment reform during the development of ACO. Some experi- ences were summarized as below： ACO can make sure that health service should be continuous and be patient-cen- tered; resources and information should be shared to improve efficiency;incentive mechanism should be built to make providers participate initiatively;regulations on doctors should be strengthened. While some challenges emerged sim- ultaneously such as scale of ACO, general advancement of payment reform, potential monopoly, patient attribution and information sharing. Finally, some implications were given to China＇ s integration of health delivery： health pro- viders are the key partner to achieve integrated care; appropriate incentive mechanism is the premise and foundation to integrate health delivery system effectively; cost containment, quality improvement and efficiency should be bal- anced during the integration of health delivery ; provider monopoly should be prevented while integrating health deliv- ery system in order to avoid higher health service price and inappropriate growth of health expenditure ; perfect infor- mation system is an important element of health system reform and its sustainable development.