按绩效支付及其对医疗机构成本影响研究综述

目的:综述与绩效支付相关的医疗机构成本项目,为进一步量化绩效支付对医疗机构经济运行的影响提供参考。方法:采用系统综述法,检索国内外机构层面绩效支付的实证研究,并从绩效考核,绩效改进以及绩效激励三方面归集成本项目。结果:共得到141篇文献,中文47篇,英文94篇。中文文献研究对象以基层医疗卫生机构为主,而英文研究主要以医院为主。机构绩效支付导致医疗机构在基础资源配置、服务提供以及监管等方面的显性成本发生变动,同时机构在组织管理的不同层面产生大量的隐性成本。结论:(1)国内外相关研究关注的成本项目存在差异,这可能与绩效支付体系的完善程度,相关配套措施以及政策环境有关;(2)与医疗机构运行相关的隐性成本尽管得到了学者的关注,但是缺乏相应的量化研究;(3)现有的与按绩效支付相关的经济学评价主要是基于社会以及服务购买者的视角,且没有将隐性成本纳入成本计算范畴。

Review on the pay for performance impact on hospital costs

Objective: To analyze the pay for performance related costs and provide suggestions for further study. Methods: Empirical literatures from inside the country and overseas were collected with a systematic review. Costs were summarized on the basis of three drivers (performance appraisal, performance improvement and incentive performance). Results: A total of 141 papers, 47 in Chinese and 94 in English were enrolled. Most papers in Chinese were subjected on healthcare facilities while the English ones emphasized on hospitals. Pay for performance may lead to the healthcare service costs, regulation costs and the resources allocation related costs reduction. In addition to these visible costs, a large amount of others hidden from different hospital management levels were also due to pay for performance. Conclusions: (1) Differences in costs could be found from home and overseas experience which perhaps resulted from the pay for performance, the supporting measures and the policy development. (2) More attention should be paid to the quantification researches on the health facilities' hidden costs. (3) Most available researches focus on pay for performance cost-effectiveness from the society and service purchase but not the providers' perspective and the hidden costs were also ignored.