标题：The main health goals and key processes of integrated care organization as the principal base of job’s agreement with medical staff – influence on effectiveness and quality of care
出版社：Utrecht University, Maastricht University, Groningen University
摘要：The abstract presents business case of Polish medical organization, Medical and Diagnostic Centre in Siedlce (Polish acronym CMD), which developed and introduced with success own model of coordinated health care for over 84 000 patients, habitants of Mazowieckie and Lubelskie Voivodships. The way of medical staff remuneration is one of the key factor of this success gained by local integrated care company working in a small scale. Introduction of this type of payment method in all medical facilities in a scale of whole country, knowing reality of Polish health care market seems to be almost impossible, but on the other hand public demand for effective and high quality health care service during last years increased a lot and with no doubts will increase also in coming future. This demand and lesson learned by Medical and Diagnostic Centre in Siedlce can be used by decision makers of any health care system. Introduction : Medical and Diagnostic Centre in Siedlce (CMD), prior to introduction of “homemade” program which consist of complex health check of adults with important part of prevention activity (screenings of breast, cervix, colon and lung cancers as well as heard diseases) and active approach proposed to patient with chronic disease, had introduced remuneration system for GP and then for all medical staff, which principal base are strictly linked to main health goals and key processes of the organization. The experience with payments for physicians, nurses, midwives and coordinators which has been gain during last few years allows managers of CMD for permanent development of remuneration system for medical staff of the company which influence further increase of effectiveness and quality of health care provided for patients. Objectives : To assess if traditional way of remuneration of primary health care staff based on pure capitation and fee for service for some services without assessment of results, common in most primary health care facilities in Poland, can bring the same results as a remuneration system based on medical staff activity and achieving results. Methods : A comparison of results of screening programs between companies with “traditional” model of remuneration and passive approach to screening programs (breast, cervix and heard diseases) versus CMD case, company with active approach towards preventive activity due to the fact of active payment method used by the company owners and managers permanently increasing effectiveness and quality of care given to patients. Results : Results proves that active approach to screening programs which is promoted and influenced by financial motivation in remuneration system of Medical and Diagnostic Center in Siedlce is much better than average results in both voivodships, Mazowieckie and Lubelskie, where CMD is active. This results are fully linked with activity of medical staff of primary health care organization in the field of prevention. Conclusions : Example of CMD proved, that without prior implementation of working and proven remuneration system based on controlled and financially motivated activity of medical staff, increase of results of any screening programs, as well as population health, effectiveness and quality of care would not be successful.
关键词：active remuneration ; medical staff ; effectiveness ; prevention ; health results ; quality of care
