美国加利福尼亚州以价值为本的按绩效付费项目及其对我国全科医生绩效考核体系和激励机制的启示

The Enlightenment of Value-based Pay for Performance Program in California on Improving the Performance Evaluation System and Incentive Mechanism of General Practitioners in China

完善的全科医学服务激励机制和绩效考核体系是健全我国全科医生制度的核心要素。本文对美国加利福尼亚州以价值为本的按绩效付费(VBPFP)项目进行了深入分析,重点阐述其绩效考核体系和激励方案,并将其与我国全科医生的绩效考核体系和激励机制进行对比。VBPFP项目对全科医生的绩效考核目标明确,要求全科医生既要控制医疗费用又要提高医疗质量,考核内容重点关注和评价慢性病的预防与治疗;激励机制采用混合式医保支付方式以最大限度刺激全科医生服务积极性。由此,建议我国在完善全科医生绩效考核体系时,重点增加疾病预防与健康管理的考核指标。其次,要建立与医保挂钩的混合式支付方式,及时公开全科医生的绩效考核结果,公开奖励绩效突出的全科医生以激发其工作积极性。

A well-run incentive mechanism and performance evaluation system are key to improve the general practitioner system in China.This study thoroughly analyzed value-based pay for performance program(VBPFP)in California,with emphasis on its performance measures and incentive mechanism and compared it with that in China.On the basis of the comparative analysis,we found that the performance evaluation goals of VBPFP program was specific,which required general practitioners to pay equal attention to the quality and cost of patient care.The performance measures were mainly centered on the prevention and treatment of chronic diseases.The hybrid medical insurance payment methods were adopted to maximize the enthusiasm of general practitioners.Therefore,we put forward suggestions that our performance assessment should add indicators of chronic disease prevention and health management and that we should establish a hybrid payment method links to the medical insurance for general practitioners.In addition,timely disclosure of general practitioners'performance appraisal results and open recognition and reward for general practitioners with outstanding performance are also important to stimulate their enthusiasm at work.