当前,全球医疗支出快速增长,但健康改善效果并不明显,探寻医疗支出控制与质量提升并行的价值医疗路径成为各国共识。医保支付方式改革是破解该困境的关键抓手,而患者报告结局（Patient-Reported Outcome, PRO）能够反映患者主观健康状态,是连接价值医疗理念与医保支付实践的重要纽带。本研究聚焦PRO在医保支付中的关键作用,梳理了英国、瑞典、美国三个国家将PRO嵌入医保支付的路径、激励机制与运行效果。研究发现,三国均依靠标准化信息平台收集PRO数据,选择择期手术病种开展基于PRO的支付试点,实现了医疗成本控制及医疗质量提升的双重目标。我国可借鉴国际经验,建立本土化的PRO评估工具与统一的信息平台,构建主客观结合的评价体系及医保支付机制,推动医疗服务向价值医疗转型。
Abstract
Currently, global healthcare expenditure has increased rapidly, while improvements in health outcomes have remained relatively limited. Identifying strategies that simultaneously contain costs and improve quality has therefore become a shared priority across healthcare systems. Health insurance payment reform is widely regarded as a critical policy lever, and patient-reported outcome (PRO), which reflects patients' subjective health status, provide an important linkage between the principles of value-based healthcare and payment practice. This study examines the role of PRO in health insurance payment systems, drawing on comparative case studies from the United Kingdom, Sweden and the United States. We analyze the pathways through which PROs have been incorporated into payment arrangements, with particular attention to incentive mechanisms and implementation outcomes. The results indicate that all three countries rely on standardized information platforms to collect PRO data and have primarily implemented PRO-based payment pilots in elective surgical services. These initiatives have contributed to both cost containment and improvements in healthcare quality. Based on international experience, China may consider developing PRO measurement instruments, establishing unified information platforms, and constructing evaluation and payment frameworks that integrate both objective clinical indicators and patient-reported outcomes, thereby supporting the transition toward value-based healthcare.
关键词
患者报告结局 /
价值医疗 /
医保支付
Key words
patient-reported outcome /
value-based healthcare /
medical insurance payment
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基金
中国医学科学院医学与健康科技创新工程“基于卫生健康体系学的健康中国建设战略研究”（2021-I2M-1-046）
