按绩效支付方式对门诊服务机构绩效的效果评价

Effectiveness evaluation of pay-for-performance for outpatients care services

门诊服务机构提供的服务是病人首先接触和最基本的医疗保健,门诊服务对居民健康状况有最直接的影响。支付方式是购买者最常用的引导服务提供者行为的激励机制。本研究通过Cochrane系统综述的方法,检索、筛选、评价和整合原始研究,并最终纳入19项研究。研究发现,现有支付方式结合按绩效支付的干预方式可以略促进某些检查或治疗项目的开展(调整后RR值中位数=1.095,range 1.01 to 1.17);但可能无法改变病人卫生服务利用行为(调整后RR值中位数=1.01,range 0.96 to 1.15)和健康状况的改善(调整后RR=1.01,range 0.98 to 1.04)。按绩效支付设计较复杂,每个细节设计都可能蕴含不同的激励效果,因此,决策者在设计经费支付方式或者实行按绩效支付改革但效果不明显时,应分析支付方式各个模块的设计,以寻找干预点。

Outpatient care services are usually the patient＇s first contact between the patients and the most basic health care. The provision of outpatient care contributes to immediate and large gains in health status. The pay- ment method is one of the most common incentive methods applied by purchasers to guide the performance of outpa- tient care providers. This systematic review applied cochrane review method, and searched, screened, assessed and synthesized the relevant original studies. 19 studies were finally included. It was found that existing payment methods combined with P4P interventions could probably slightly improved the health professionals＇ use of some tests and treat- ments （adjusted RR median = 1. 095, range 1.01 to 1.17）, but may have led to little or no difference in patients＇ utilisation of health services （ adjusted RR median = 1.01, range 0.96 to 1.15 ） and may have led to little or no difference in the control of blood pressure or cholesterol （adjusted RR = 1.01, range 0.98 to 1.04）. Pay for performance involves a complex design, each detail design may contain different incentive effect, therefore policy makers intend to apply pay-for-performance to guide the behavior of health providers, the design on each components of pay for performance should be analyzed in order to find more potential intervention points.