2021—2022年版英国质量与结果框架的设计及其对我国的启示  

Design of the UK Quality and Outcomes Framework for 2021—2022 and Its Implications for China

作　　者：李雪竹 匡莉[1] 张慧[1] LI Xuezhu;KUANG Li;ZHANG Hui(School of Public Health,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学公共卫生学院,广东省广州市510080

出　　处：《中国全科医学》2022年第28期3466-3474,共9页Chinese General Practice

基　　金：国家自然科学基金资助项目(71704194);美国中华医学基金会公开竞标项目(19-339)。

摘　　要：我国基层医疗卫生机构在承担基本公共卫生服务和基本医疗服务项目方面存在绩效考核体系和支付制度不完善的问题。英国质量与结果框架(QOF)经过多次调整,最新版本更加注重慢性病防控与疾病管理质量。本研究从管理与运作体系、指标体系的演变历程及新版(2021—2022年版)指标构成、计分规则和按绩效付费规则等方面对英国QOF进行介绍,并剖析了英国新版QOF的设计细节和运行情况。本研究发现,英国QOF是一个以结果为导向的质量控制系统和以报酬为导向的激励机制,其以主要慢性病及其危险因素为管理重点,通过设置三级指标体系,并规定指标分值和每分值对应的金额,实现将全科诊所服务质量与其绩效报酬相联系,能够从整体上提高英国卫生系统的效能。借鉴QOF的经验,我国应完善基本公共卫生服务规范与绩效考核指标体系、基层门诊慢性病支付方式,促进基本公共卫生服务资金和基本医疗保险基金的统筹使用。In China,the performance appraisal system measuring the performance in delivering essential public health services and medical services,and the patient payment system for these services in primary health institutions are still imperfect.The UK Quality and Outcomes Framework(QOF)has been modified many times,and the latest version(2021—2022)places more emphasis on chronic disease prevention and control and the quality of disease management.We introduced the UK QOF,involving its management and operation system,modification process of the indicators,and the indicator composition,scoring rules and performance management of its latest version,particularly detailed the design and operation of its latest version,and summarized the following insights:the UK QOF is a result-oriented quality control system and a reward-oriented incentive mechanism,which focuses on the management of major chronic diseases and their risk factors.Through the establishment of a three-level management system for each major disease,with defined scores and corresponding payment for the indicators,the general practices obtain the payment according to their service quality,thereby increasing the efficiency of the healthcare system in the UK as a whole.The design and operation of the UK QOF will contribute to the improvement of China's national essential public health service specifications and performance assessment systems as well as payment methods for chronic disease outpatient management services in primary care,which in turn boosts the appropriate allocation of the fund for essential public health services and the basic medical insurance fund generally.

关 键 词：质量与结果框架 按绩效付费 基本公共卫生服务 基本医疗服务 国家卫生服务 英国 

分 类 号：R197.1[医药卫生—卫生事业管理]