Une \u00e9tude men\u00e9e aux \u00c9tats-Unis examine la rentabilit\u00e9 pour les cabinets et centres de soins primaires (PCC) de participer \u00e0 des dispositifs d\u2019assurance maladie avec partage des co\u00fbts par paliers (\u00ab tiered cost-sharing \u00bb), fond\u00e9s sur le co\u00fbt total annuel de prise en charge par patient, ajust\u00e9 du risque (TCOC). Dans ce type de mod\u00e8le, les PCC dont le TCOC est le plus faible sont plac\u00e9s dans un palier offrant un moindre reste \u00e0 charge pour les patients, ce qui peut accro\u00eetre leur patient\u00e8le.<\/p>\n
Les auteurs \u00e9laborent un mod\u00e8le g\u00e9n\u00e9ral de retour sur investissement (ROI) pour les PCC dans ce cadre. Ils s\u2019int\u00e9ressent en particulier \u00e0 l\u2019effet de baisses de prix consenties par les PCC afin de r\u00e9duire leur TCOC et d\u2019acc\u00e9der \u00e0 un palier plus avantageux pour les patients. L\u2019analyse, appliqu\u00e9e \u00e0 des donn\u00e9es issues d\u2019un important r\u00e9gime d\u2019assurance d\u2019un \u00c9tat am\u00e9ricain pour ses agents publics, repose sur l\u2019hypoth\u00e8se que ces r\u00e9ductions tarifaires ou autres efforts non r\u00e9mun\u00e9r\u00e9s (par exemple pour rendre le PCC plus attractif dans un syst\u00e8me \u00e0 capitation) ne sont pas directement compens\u00e9s par l\u2019assureur.<\/p>\n
Les r\u00e9sultats indiquent que des remises de l\u2019ordre de 10 \u00e0 20 % sur les tarifs peuvent g\u00e9n\u00e9rer un ROI positif pour les PCC dans ce type de design : l\u2019augmentation du volume de patients li\u00e9e \u00e0 l\u2019appartenance \u00e0 un palier de moindre partage de co\u00fbts peut compenser, voire d\u00e9passer, la perte de revenu unitaire induite par les rabais. Toutefois, les auteurs soulignent que ces r\u00e9sultats sont fortement sensibles aux param\u00e8tres retenus dans le mod\u00e8le (par exemple structure de co\u00fbts, ampleur de l\u2019augmentation de la patient\u00e8le), ce qui limite la g\u00e9n\u00e9ralisation des conclusions.<\/p>\n
Pour les d\u00e9cideurs publics, cette \u00e9tude illustre les conditions dans lesquelles des dispositifs d\u2019assurance incitant les soins primaires \u00e0 r\u00e9duire le co\u00fbt total de prise en charge, via des m\u00e9canismes de paliers de reste \u00e0 charge, peuvent aligner les objectifs des pouvoirs publics et des prestataires priv\u00e9s. Elle met cependant en \u00e9vidence la n\u00e9cessit\u00e9 de prendre en compte les contraintes \u00e9conomiques des cabinets de soins primaires et l\u2019incertitude li\u00e9e aux hypoth\u00e8ses de mod\u00e9lisation avant de s\u2019appuyer sur de tels dispositifs pour atteindre des objectifs de ma\u00eetrise des d\u00e9penses et d\u2019am\u00e9lioration de la qualit\u00e9 des soins.(contenu r\u00e9sum\u00e9 en fran\u00e7ais par l’IA)\u00a0Lire la Suite<\/a><\/p>","protected":false},"excerpt":{"rendered":" Une \u00e9tude men\u00e9e aux \u00c9tats-Unis examine la rentabilit\u00e9 pour les cabinets et centres de soins primaires (PCC) de participer \u00e0 des dispositifs d\u2019assurance maladie avec partage des co\u00fbts par paliers […]<\/p>\n","protected":false},"author":1,"featured_media":10675,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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