以价值为基础的补偿机制在医疗保健系统中实现社会和财务影响

Ana Paula de Silva Etges, Harry Liu, Porter Jones, Carisi Polanczyk
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引用次数: 0

摘要

在不断寻求建立可持续的医疗保健系统的过程中,考虑了基于价值的报销策略。对于已经实施的模式,根据患者的临床状况和所有利益相关者之间的风险平衡,根据患者消费概况的具体细节来证明成功。从按服务收费到基于价值的捆绑支付策略,使用准确的患者成本和结果信息的方式各不相同,导致利益攸关方之间达成不同的风险协议。全面了解基于价值的报销协议,将此类协议视为风险管理机制,对于确保医疗保健系统在确保财务可持续性的同时产生社会影响的任务至关重要。这篇观点文章侧重于从社会和财务角度对基于价值的报销策略对医疗保健系统的影响进行批判性分析。对基于价值的报销的文献进行了批判性分析,以确定这些策略如何影响医疗保健系统。文献分析之后的概念描述,以价值为基础的补偿协议的机制,以实现社会和财务影响的医疗保健系统。没有一条成功的支付改革之路。支付改革被用作重新设计系统组织方式的策略,以向患者提供护理,其成功实施导致文化,社会和金融变革。关于使用价值补偿战略和商业模式可以通过减少保健不平等和改善人口健康来提高效率和产生社会影响的说法,利益攸关方已达成共识。然而,这些新战略的成功实施涉及财务和社会风险,需要所有利益相关者更好地管理。使用尖端技术是管理这些风险的重要进展,必须与注重改善人口健康从而提高价值的强有力领导相配合。支付改革被用作重新设计如何组织系统以向患者提供护理的机制,其成功实施预计将导致医疗保健系统的社会和财务修改。
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Value-based Reimbursement as a Mechanism to Achieve Social and Financial Impact in the Healthcare System
Value-based reimbursement strategies have been considered in the continuous search for establishing a sustainable healthcare system. For models that have been already implemented, success is demonstrated according to specific details of the patients’ consumption profile based on their clinical condition and the risk balance among all the stakeholders. From fee-for-service to value-based bundled payment strategies, the manner in which accurate patient-level cost and outcome information are used varies, resulting in different risk agreements between stakeholders. A thorough understanding of value-based reimbursement agreements that views such agreements as a mechanism for risk management is critical to the task of ensuring that the healthcare system generates social impacts while ensuring financial sustainability. This perspective article focuses on a critical analysis of the impact of value-based reimbursement strategies on the healthcare system from a social and financial perspective. A critical analysis of the literature about value-based reimbursement was used to identify how these strategies impact healthcare systems. The literature analysis was followed by the conceptual description of value-based reimbursement agreements as mechanisms for achieving social and financial impacts on the healthcare system. There is no single successful path toward payment reform. Payment reform is used as a strategy to re-engineer the way in which the system is organized to provide care to patients, and its successful implementation leads to cultural, social, and financial changes. Stakeholders have reached consensus regarding the claim that the use of value reimbursement strategies and business models could increase efficiency and generate social impact by reducing healthcare inequity and improving population health. However, the successful implementation of such new strategies involves financial and social risks that require better management by all the stakeholders. The use of cutting-edge technologies are essential advances to manage these risks and must be paired with strong leadership focusing on the directive to improve population health and, consequently, value. Payment reform is used as a mechanism to re-engineer how the system is organized to deliver care to patients, and its successful implementation is expected to result in social and financial modifications to the healthcare system.
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CiteScore
3.00
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0.00%
发文量
55
审稿时长
10 weeks
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