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首页> 外文期刊>International Journal of Integrated Care >Incentives for telehealthcare deployment that support integrated care: a comparative analysis across eight European countries
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Incentives for telehealthcare deployment that support integrated care: a comparative analysis across eight European countries

机译：支持集成医疗的远程医疗部署激励措施：八个欧洲国家的比较分析

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Introduction: Health care systems are struggling to deal with the increasing demands of an older population. In an attempt to find a solution to these demands, there has been a shift towards integrated care supported by information and communication technologies. However, little is understood about the role played by incentives and reimbursement schemes in the development of integrated care and information and communication technologies uptake. The objective of this paper is to investigate this question, specifically as regards telehealthcare. Methods: In order to identify the deployment of telehealthcare applications and their role in supporting integrated care, a case study approach was used. A clustering exercise was carried out and eight European countries were selected for in-depth study: Denmark, Estonia, Germany, France, Italy, the Netherlands, Spain and the UK. In total, 31 telehealthcare initiatives across eight countries involving over 20,000 patients were investigated. Results: Reflecting on specific examples in each initiative, drivers promoting integrated care delivery supported by telehealthcare mainstreaming and associated incentive mechanisms were identified. Attention was also paid to other factors which acted as barriers for widespread deployment. Discussion and conclusions: Trends towards telehealthcare mainstreaming were found in Denmark, the UK, and in some regions of Spain, Italy and France. Mainstreaming often went hand-in-hand with progress towards integrated care delivery and payment reforms.A general trend was found towards outcomes-based payments and bundled payment schemes, which aimed to promote integrated care supported by telehealthcare deployment. Their effectiveness in achieving these goals remains to be seen.In addition, a form of outpatient diagnostic-related group reimbursement for telehealthcare services was found to have emerged in a few countries. However, it is questionable how this incentive could promote integrated care delivery on its own.This research suggests that incentives which align social, primary and hospital care are rare and there is a need to design new payment paradigms.Finally, eHealth penetration, interoperability, governance, availability of evidence and reorganisation of services represent additional factors which can act as drivers or barriers for integrated care delivery.
机译：简介：医疗保健系统正在努力应对老年人口不断增长的需求。为了找到满足这些需求的解决方案，已经朝着信息和通信技术支持的综合护理的方向发展。但是，对于奖励和报销计划在发展综合护理以及信息和通信技术中所起的作用知之甚少。本文的目的是调查这个问题，特别是有关远程医疗的问题。方法：为了确定远程医疗保健应用程序的部署及其在支持集成医疗中的作用，使用了案例研究方法。进行了分组研究，并选择了八个欧洲国家进行深入研究：丹麦，爱沙尼亚，德国，法国，意大利，荷兰，西班牙和英国。总共对八个国家的31个远程医疗保健计划进行了调查，涉及20,000多名患者。结果：反思每个倡议中的具体示例，确定了在远程医疗主流化和相关激励机制支持下促进综合医疗服务的驱动因素。还注意了其他因素，这些因素阻碍了广泛部署。讨论与结论：在丹麦，英国以及西班牙，意大利和法国的某些地区发现了远程医疗主流化的趋势。主流化通常与综合医疗服务提供和支付改革的进步并驾齐驱，发现基于结果的支付和捆绑式支付计划的总体趋势是普遍趋势，其目的是在远程医疗部署的支持下促进综合医疗服务。它们在实现这些目标方面的效果还有待观察。此外，在一些国家中发现了一种形式的与门诊相关的团体报销远程医疗服务的形式。但是，这种激励措施如何独自促进综合医疗服务的提供还存在疑问。这项研究表明，结合社会，初级和医院医疗保健的激励措施很少见，因此有必要设计新的支付方式.eHealth的普及率，互操作性，治理，证据的可获得性和服务的重组代表了其他因素，这些因素可能会成为综合医疗服务提供的驱动力或障碍。

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