责任医疗体系的国际经验借鉴与启示
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摘要
随着人均预期寿命的不断增长,服务模式逐渐向综合、协调、连续、安全和可及性的方向转变,卫生体系与筹资机制有责任进行改革,以实现更好的健康结果。文章通过文献综述,对责任医疗体系与责任医疗机构的概念进行了区分,介绍了国际上4个责任医疗体系的基本要素。启示包括利益相关者共同参与、支付方式与健康产出挂钩、数据与信息化工具支持、实现三重目标与四重目标等。相关经验可以为我国医疗卫生体制改革提供借鉴。
As the life expectancy grows, the care model is gradually transforming to comprehensive, integrated, continuous, safe and accessible care. In order to accomplish better health outcomes, healthcare system and financing system have the responsibility to reform. By literature review, this article distinguished the concepts of accountable acre system and accountable care organization, introduced four internationally known accountable care systems, and their key elements. Inspirations included engagement of all stakeholders, payment tied up health outcomes, data and informatization tool support, and realizing triple aim and quadruple aim. Relevant experience can be references to healthcare system reform in China.
As the life expectancy grows, the care model is gradually transforming to comprehensive, integrated, continuous, safe and accessible care. In order to accomplish better health outcomes, healthcare system and financing system have the responsibility to reform. By literature review, this article distinguished the concepts of accountable acre system and accountable care organization, introduced four internationally known accountable care systems, and their key elements. Inspirations included engagement of all stakeholders, payment tied up health outcomes, data and informatization tool support, and realizing triple aim and quadruple aim. Relevant experience can be references to healthcare system reform in China.
引文
[1] 李陈晨,王芳,薛婉君. 美国整合卫生保健主要做法及启示[J]. 中国卫生经济, 2014, 33(8): 90-93.
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[3] Summers LH. Economists’ declaration on universal health coverage[J]. The Lancet, 2015,386(10008): 2112-2113.
[4] Yamey G. Implementing pro-poor universal health coverage[J]. The Lancet, 2015,4(1): e14–16.
[5] Mark McClellan, Andrea Thoumi, Krishna Udayakumar. Implementing Accountable Care to Achieve Better Health At A Lower Cost[R]. WISH Accountable Care Forum, 2016: 3-6.
[6] British Medical Association. Accountable care systems: what are they and what do they mean for the NHS[R]. London: British Medical Association. 2017: 1-2.
[7] 王梦媛,颜建周,张伶俐. 美国节余分享计划下的责任医疗组织制度研究[J]. 卫生经济研究, 2017,1(357):53-57.
[8] Alexander Pimperl, Helmut Hildebrandt, Oliver Groene, et al. Case Study: Gesundes Kinzigtal, Germany[R]. Duke-Margolis Center for Health Policy, the Commonwealth Fund. 2013:1-14.
[9] The Kings Fund. Gesundes Kinzigtal, Germany[EB/OL]. The Kings Fund[2015-2-23]. https://www.kingsfund.org.uk/publications/population-health-systems/gesundes-kinzigtal-germany[2017-9-20].
[10] Andrea Thoumi, Elizabeth Drobnick, Monica Maday, et al. Spain: Reinventing Chronic Care Management for the Elderly[R]. Washington, DC: Center for Health Policy at Brookings. 2013:3-12.
[11] Amanda Sullivan, Lucy Dadge. Better Together, United Kingdom. Duke-Margolis Center for Health Policy, the Commonwealth Fund. 2013:1-11.
[12] NHS. New Care Models: Vanguards - developing a blueprint for the future of NHS and care services[R]. London: NHS. 2016:3-8.
[13] Amanda Sullivan, Lucy Dadge, Krishna Udayakumar, et al. Case Study: Better Together, United Kingdom[R]. Duke-Margolis Center for Health Policy, the Commonwealth Fund. 2013:1-11.
[14] Hubertus J.M. V., Anna R. H. Case Study: Zio Integrated Care Network, The Netherlands[R]. Duke-Margolis Center for Health Policy, the Commonwealth Fund. 2013:1-11.
[15] Charles L, Moe J, Bartlett R. One Family Health Rwanda: Achievements and challenges 2012[M]. Durham: International Partnership for Innovative Healthcare Delivery. 2013:3-4.
[16] Possible. Possible[EB/OL]. https://possiblehealth.org/[2017-10-11].
[17] Donald M. Berwick, Thomas W. Nolan, John Whittington. The Triple Aim: Care, Health, And Cost[J]. Health Affairs 2008,3,(27):759-769.
[18] Rishi Sikka, Julianne M Morath, Lucian Leape. The Quadruple Aim: care, health, cost and meaning in work[J]. BMJ Quality & Safety, 2015,24(10):608.
[19] Thomas Bodenheimer, Christine Sinsky. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider[J]. Annals of Family Medicine, 2014, 12(6):573-576.
[20] Diane R. R, Stephen M. S, Elliott S. F. Primary Care and Accountable Care - Two Essential Elements of Delivery-System Reform[J]. The New England Journal of Medicine, 2009, 361(24): 2301-2303.
[21] 李洁,David Qian. NHS制度背景下英国医药产业政策体系探析与启示[J]. 中国卫生事业管理, 2016 , 33 (11) :806-808.
[22] NHS. NHS moves to end “fractured” care system. NHS[2017-6-15]. https://www.england.nhs.uk/2017/06/nhs-moves-to-end-fractured-care-system/[2017-9-22].
[2] World Health Organization. Health systems financing: The path to universal coverage (World Health Report)[R]. Geneva: World Health Organization. 2010:1.
[3] Summers LH. Economists’ declaration on universal health coverage[J]. The Lancet, 2015,386(10008): 2112-2113.
[4] Yamey G. Implementing pro-poor universal health coverage[J]. The Lancet, 2015,4(1): e14–16.
[5] Mark McClellan, Andrea Thoumi, Krishna Udayakumar. Implementing Accountable Care to Achieve Better Health At A Lower Cost[R]. WISH Accountable Care Forum, 2016: 3-6.
[6] British Medical Association. Accountable care systems: what are they and what do they mean for the NHS[R]. London: British Medical Association. 2017: 1-2.
[7] 王梦媛,颜建周,张伶俐. 美国节余分享计划下的责任医疗组织制度研究[J]. 卫生经济研究, 2017,1(357):53-57.
[8] Alexander Pimperl, Helmut Hildebrandt, Oliver Groene, et al. Case Study: Gesundes Kinzigtal, Germany[R]. Duke-Margolis Center for Health Policy, the Commonwealth Fund. 2013:1-14.
[9] The Kings Fund. Gesundes Kinzigtal, Germany[EB/OL]. The Kings Fund[2015-2-23]. https://www.kingsfund.org.uk/publications/population-health-systems/gesundes-kinzigtal-germany[2017-9-20].
[10] Andrea Thoumi, Elizabeth Drobnick, Monica Maday, et al. Spain: Reinventing Chronic Care Management for the Elderly[R]. Washington, DC: Center for Health Policy at Brookings. 2013:3-12.
[11] Amanda Sullivan, Lucy Dadge. Better Together, United Kingdom. Duke-Margolis Center for Health Policy, the Commonwealth Fund. 2013:1-11.
[12] NHS. New Care Models: Vanguards - developing a blueprint for the future of NHS and care services[R]. London: NHS. 2016:3-8.
[13] Amanda Sullivan, Lucy Dadge, Krishna Udayakumar, et al. Case Study: Better Together, United Kingdom[R]. Duke-Margolis Center for Health Policy, the Commonwealth Fund. 2013:1-11.
[14] Hubertus J.M. V., Anna R. H. Case Study: Zio Integrated Care Network, The Netherlands[R]. Duke-Margolis Center for Health Policy, the Commonwealth Fund. 2013:1-11.
[15] Charles L, Moe J, Bartlett R. One Family Health Rwanda: Achievements and challenges 2012[M]. Durham: International Partnership for Innovative Healthcare Delivery. 2013:3-4.
[16] Possible. Possible[EB/OL]. https://possiblehealth.org/[2017-10-11].
[17] Donald M. Berwick, Thomas W. Nolan, John Whittington. The Triple Aim: Care, Health, And Cost[J]. Health Affairs 2008,3,(27):759-769.
[18] Rishi Sikka, Julianne M Morath, Lucian Leape. The Quadruple Aim: care, health, cost and meaning in work[J]. BMJ Quality & Safety, 2015,24(10):608.
[19] Thomas Bodenheimer, Christine Sinsky. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider[J]. Annals of Family Medicine, 2014, 12(6):573-576.
[20] Diane R. R, Stephen M. S, Elliott S. F. Primary Care and Accountable Care - Two Essential Elements of Delivery-System Reform[J]. The New England Journal of Medicine, 2009, 361(24): 2301-2303.
[21] 李洁,David Qian. NHS制度背景下英国医药产业政策体系探析与启示[J]. 中国卫生事业管理, 2016 , 33 (11) :806-808.
[22] NHS. NHS moves to end “fractured” care system. NHS[2017-6-15]. https://www.england.nhs.uk/2017/06/nhs-moves-to-end-fractured-care-system/[2017-9-22].