Kişiye Özel Sağlık Hizmetlerinde Koordinasyon Programının Maliyet Kontrolü Bağlamında Değerlendirilmesi: Amerika Birleşik Devletleri’ndeki Cambridge Health Alliance Örneği

Yıl 2015, Cilt: 5 Sayı: 1, 165 - 189, 23.03.2015

Kadir Gürsoy

Öz

Amerika’da
artan sağlık giderleri, sağlık sektöründeki paydaşlar için büyük bir sorun
oluşturmaktadır. Bu yüzden her paydaş, maliyetleri kısma adına yeni stratejiler
geliştirmektedirler. Kişiye özel sağlık hizmetlerinin koordinasyonu, bu sorunu
çözme adına sağlık hizmeti sunucuları tarafından geliştirilen yöntemlerden bir
tanesidir. Cambridge Health Alliance – büyük Boston sınırları içinde hizmet
veren kamu güvenlik ağı sağlık sistemi sunucusu – Kasım 2011’den bu yana örnek
bir grup için koordinasyon programının pilot uygulamasını yapmaktadır.  Bu makale, bu programın sağlık maliyetleri
üzerine etkisini ölçmekte, örmek grup içindeki farklı alt grupların hangisinin
maliyetleri daha çok aşağıya çektiğini anlamak için maliyet yapısını analiz
etmekte ve en büyük tasarrufu sağlamak için önerilerde bulunmaktadır.
Analizler, programın maliyet dağılımını değiştirmede başarılı olduğu ve
programın en maliyetli hastaları kapsaması durumunda maliyet artış hızında
azalma sağladığı sonuçlarına ulaşmaktadır. Ama, analizlerin daha büyük bir
örneklemi ve daha uzun süreli kontrol dönemini içerecek şekilde geliştirilmeye
ihtiyacı vardır. Son olarak, programın; koruyucu sağlık, uzun dönemde
maliyetleri sürdürülebilir hale getirecek yeni ödeme sistemleri, aile hekimi
sistemi gibi başka politikalarla desteklenmesi önem arz etmektedir.  

 

Anahtar Kelimeler

Sağlık hizmetlerinin koordinasyonu, artan sağlık giderleri, maliyet kontrolü, proje değerlendirmesi

Evaluation of Care Coordination Program on Cost Containment: Cambridge Health Alliance Case in the United States

Öz

Rising healthcare
costs in nearly all nations, particularly in the United States, has been posing
major challenges to stakeholders in healthcare industry.  Each actor has been developing new strategies
to mitigate costs. Care coordination is one of the methods many healthcare
providers have been applying to remedy this problem. Cambridge Health Alliance
- a public, safety net health care system serving the Greater Boston area- has
been piloting a care coordination program for one of its population cohorts
since November 2011. This paper evaluates the possible impact of the program on
healthcare costs, analyzes cost structure for different sub-populations to
understand which groups contribute most to cost reductions, and offer
suggestions to achieve the highest saving. The analyses conclude there is room
for curbing the cost growth when the program targets the highest cost patient
and the program succeeds in changing the cost concentration of healthcare spending.
Nevertheless, the analyses need to be developed further, using bigger
population and a longer intervention period. Finally, it is important to
support the program with other policies such as a gate keeping system,
preventive care, and new alternative payment systems to sustain an impact on
costs in the long-run.

Anahtar Kelimeler

Care coordination, rising healthcare costs, cost containment, project evaluation

Kaynakça

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