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| 投稿时间： 2014-08-12 最后修改时间： 2014-09-08 摘要点击次数: 3127 全文下载次数: 1635 |
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| 引用本文：袁莎莎, 孟庆跃.医疗服务质量和费用关系的国际研究综述[J].中国卫生政策研究,2014,7(10):46-51 |
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| 袁莎莎1,2, 孟庆跃3 |
1. 中国医学科学院医学信息研究所/卫生政策与管理研究中心 北京 100020;
2. 山东大学卫生管理与政策研究中心 山东济南 250012;
3. 北京大学中国卫生发展研究中心 北京 100191 |
| 基金项目:欧盟“亚洲健康和公平疾病风险研究” (HEALTH-F2-2009-223166);中央级公益性科研院所基本科研业务费(13R0112) |
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| | 摘要:医疗服务质量和费用是卫生保健系统经常面临的两个互相竞争的关键要素.医疗费用的不断上涨是否带来质量的提升是不同卫生保健系统共同关注的问题,解决该问题的核心在于了解医疗服务质量和费用之间的关系.本文通过对国外有关质量和费用关系的理论与实践研究进行综述,基于Donabedian结构—过程—结果三维度质量框架进行归纳分析,尝试对目前该主题的研究进展进行系统梳理和展示.研究结果显示,现有研究的分析单位一般基于地区、服务提供者、病人等水平;不同研究所用到的质量指标差异较大;较多研究关注结果质量和费用的关系,而对于结构质量和过程质量与费用关系的研究尚不足;多数研究基于住院环境下,较少研究关注门诊环境,缺乏二者对比的研究.基于现有证据,尚无法对医疗服务质量和费用的关系得出一致的结论,但不同研究所用到的质量指标、数据与方法或局限性等仍值得未来的研究借鉴,以便于更客观合理的对质量和费用关系进行探讨. | |
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关键词:医疗服务质量 质量评价 医疗费用 关系
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| Correlation between quality and expenditure of medical care: a review of international studies |
| YUAN Sha-sha1,2, MENG Qing-yue3 |
1. Center for Health Policy and Management, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China;
2. Center for Health Management and Policy, Shandong University, Jinan Shandong 250012, China;
3. Peking University China Center for Health Development Studies, Beijing 100191, China |
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| | Abstract:The health care system has always faced challenges from two competing fronts: rising costs and quality concerns. The common issue of debate confronted by various health care systems is whether or not rising medical expenditure can lead to quality improvements. The key to addressing this issue is to figure out the correlation between quality of care and medical expenditure. Based on Donabedian's structure, process and outcome quality theory, this study reviews relevant international studies related to this topic in order to provide empirical evidence in a clearer way. Results show that the analysis of current studies have typically been based on the regional level, health provider level and patient level; the quality indicators used varied among studies while expenditure indicators had much in common; more studies were found to focus on the association between outcome quality and expenditure while less studies explored the link between structure or process quality and expenditure; additionally, the majority of relevant studies were located in the inpatient setting and studies from outpatient settings were found to be lacking. Overall, according to current knowledge, no inclusive conclusion could be obtained, but quality indicators, data and methods, and limitations revealed in these studies can be reviewed by future study to explore the correlation between quality and expenditure of medical care in a more objective way. | |
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