Name: 醫生如何獲得報酬？基於價值的醫療服務與收費醫療服務 (How Are Doctors Paid? Value-Based vs Fee-for-Service Care)
Uploaded: 2025-10-22T18:19:02.000Z
Duration: 9 min 54 s

Value based care is a hot topic, but is it all it's cracked up to be?

價值導向照護是個熱門話題，但它真的有這麼厲害嗎？

Jubbal medschoolinsiders.com when we explained how RVUs worked in a previous video, many of you requested we make a video on value based versus Fee for service care.

Jubbal medschoolinsiders.com 在我們之前解釋支付單位（RVUs）如何運作的影片中，許多人都要求我們製作一集關於價值導向照護對比論量計酬照護的影片。

As a pre med or medical student, you must be familiar with these terms as the debate between these two payment models will determine the future of the American healthcare system.

身為醫學預科或醫學系學生，你一定對這些術語很熟悉，因為這兩種支付模式的爭論將決定美國醫療保健系統的未來。

So what is value based care and what are the key differences between these healthcare payment systems?

那麼，什麼是價值導向照護，這兩種醫療支付系統的關鍵差異又是什麼呢？

Stick around until the end when we discuss if it's possible for the US to switch to a value based system.

請繼續收看，我們將討論美國是否有機會轉向價值導向系統。

In the United States, there are two health care payment systems, Value based Care and fee for service care, and

在美國，有兩種醫療支付系統，價值導向照護和論量計酬照護，

It's the old school traditional model of healthcare payments founded during the American Great Depression.

這是美國大蕭條時期創立的舊式傳統醫療支付模式。

Put simply, fee for service care means payments are based directly on the amount of services a patient receives, regardless of the quality of those services.

簡單來說，論量計酬照護的意思是，付款直接根據病患接受的服務量來決定，而不管服務品質如何。

The model heavily rewards patient volume as physicians are allowed to bill the patient's insurance for every office visit, lab, test or procedure they perform.

這種模式大大地獎勵病患量，因為醫師可以就他們進行的每一次門診、檢驗、檢查或處置向病患保險公司請款。

While more common among private practices, some hospitals still use fee for service care.

雖然這種模式在私人診所更常見，但有些醫院仍在使用論量計酬照護。

The model encourages physicians to see as many patients as possible as the more patients they see, the more money they make.

這種模式鼓勵醫師盡量看診，因為他們看的病患越多，賺的錢就越多。

On the plus side, if physicians are financially motivated to see as many patients as possible, there will be shorter wait times.

好的一面是，如果醫師有財務動機盡量看診，等待時間就會縮短。

In a country with a growing physician shortage, especially in primary care positions, encouraging physicians to see as many patients as possible could theoretically help keep the public healthy.

在一個醫師短缺日益嚴重的國家，尤其是在基層醫療職位，鼓勵醫師盡量看診理論上可以幫助維持大眾健康。

However, critics of this healthcare model often argue that fee for service care unethically incentivizes physicians to focus on quantity over quality.

然而，這種醫療保健模式的批評者經常認為，論量計酬照護不道德地鼓勵醫師將重點放在數量而非品質。

Another common critique is that fraud is more likely to occur as there is a financial motive to perform as many tests and procedures as possible and even if those tests are medically unnecessary.

另一個常見的批評是，詐欺更容易發生，因為有財務動機盡量進行檢查和處置，即使這些檢查沒有醫療上的必要。

We covered the fee for service payment system in more detail in our rvus video link.

我們在 RVUs 的影片中有更詳細地介紹論量計酬支付系統，連結在說明欄。

In the description Compared to value based care, fee for service is a remarkably simple model.

與價值導向照護相比，論量計酬照護是一個非常簡單的模式。

那麼，什麼是價值導向照護呢？

Since the 1960s there has been a movement to focus on the quality of medical care and achieve better health outcomes without unnecessary cost to the hospital or the patient.

自 1960 年代以來，就一直有這樣的運動，希望在不增加醫院或病患不必要費用的情況下，專注於醫療照護的品質並達成更佳的健康成果。

這為價值導向照護鋪平了道路。

Instead of reimbursing physicians for each individual service they render, value based care ties reimbursement to the quality and effectiveness of the care provided.

價值導向照護不是根據醫師提供的個別服務來支付費用，而是將支付與所提供照護的品質和有效性連結。

Now, how hospitals and Medicaid determine the quality and effectiveness of Care is where this payment model gets tricky.

現在，醫院和 Medicaid 如何決定照護的品質和有效性，就是這個支付模式變得棘手的地方。

Most often, something called patient quality measures are used.

最常見的是使用所謂的病患品質指標。

There are countless measures hospitals can use to objectively determine the quality of their care.

醫院可以透過無數的指標來客觀評估其照護品質。

For example, let's consider chronic kidney disease, or ckd.

舉例來說，我們來看看慢性腎臟病，也就是 ckd。

The hospital could assess quality by looking at the number of CKD patients on dialysis, how long CKD patients are on dialysis, the percent of dialysis patients who eventually receive a kidney transplant, or how long the patient's kidney transplant survives.

醫院可以透過觀察有多少 ckd 病患接受透析、他們接受透析多久、有多少比例的透析病患最終接受腎臟移植，或是病患的腎臟移植存活多久，來評估品質。

The possible quality measurements are limitless and and these quality measurements are often combined to assess overall patient outcomes.

品質測量的方法可以說是無窮無盡的，而且這些品質測量經常會被結合起來，用來評估病患整體的預後。

Because quality measurements are extremely difficult to weigh together and can take years to collect accurately, many hospitals have come up with creative ways to ensure they are paid for their services closer to real time.

因為品質測量很難加權計算，而且需要好幾年才能準確收集，所以許多醫院想出了創新的方法，確保他們能即時獲得服務的報酬。

Two common methods are capitation reimbursements and bundled payments.

兩種常見的方法是預付定額給付和包裹式給付。

Capitation reimbursements are when patients pay a fixed amount of money in advance every month, regardless of how many services they use.

預付定額給付是指病患每個月預先支付一筆固定金額，無論他們使用了多少服務。

For example, a patient could sign a contract saying they will pay $300 per month for access to the physician, regardless of whether they get $300 worth of care back.

舉例來說，一位病患可能會簽一份合約，表示他們每個月支付 300 美元，就能獲得醫師的照護，即使他們獲得的照護價值超過 300 美元。

Of course, this also means if the patient uses more than $300 worth of services that month, they are not charged for the extra amount.

當然，這也意味著如果病患當月使用的服務價值超過 300 美元，他們也不會被收取額外費用。

If this sounds like insurance to you, well, that's because it basically is.

如果這聽起來很像保險，那是因為它基本上就是保險。

Bundled payments are when a patient pays for a large number of visits and services they received in one lump sum.

包裹式給付是指病患一次性支付他們接受的大量門診和服務費用。

The classic example of this method is when a woman is pregnant.

這類方法的經典例子就是女性懷孕期間。

During pregnancy, many fetal checkup appointments are required.

在懷孕期間，需要進行許多胎兒的檢查門診。

The mother may need to start taking medications to promote better embryological development.

母親可能需要開始服用藥物來促進胚胎更好的發育。

And of course, they need to deliver the baby after nine long months.

當然，經過漫長的九個月後，她們也需要生產。

After the baby is born, the mother will receive a lump sum bill for all of the services they used while they were pregnant.

寶寶出生後，母親會收到一張一次性帳單，包含懷孕期間所使用的所有服務費用。

Because the hospital is able to bundle these many costs together, they sometimes provide discounts to patients.

由於醫院能夠將這些龐大的費用打包在一起，所以有時會給予病患折扣。

And since the fetus prenatal care costs are bundled, the hospital is inherently motivated to ensure the mother is as healthy as possible to help minimize the chances of complex births.

而且因為產前照護的費用是打包的，醫院自然會積極確保母親盡可能健康，以降低複雜生產的機率。

The hospital does this so it can save money while providing the same high value care.

醫院這樣做是為了在提供相同高品質照護的同時節省成本。

Value based care is much more complex than fee for service care, but

價值導向照護比論量計酬照護複雜許多，但是

it does have a few strengths that fee for service care does not.

它確實有一些論量計酬照護所沒有的優點。

For instance, value based care excels at reducing unnecessary services provided, creates physician accountability to ensure patient satisfaction, and

例如，價值導向照護在減少不必要的服務、讓醫師對病患滿意度負責，以及

鼓勵預防性健康照護方面表現出色。

That said, value based care is difficult to implement as patient outcomes can be tough to measure accurately, and

不過，價值導向照護的實施確實有難度，因為病患的結果很難準確衡量，而且

it comes with a more stressful, error prone billing process.

它的計費流程也更具壓力、容易出錯。

But the biggest criticism of value based care is that rural and smaller hospital systems are will naturally have worse outcomes as they lack the resources necessary to meet national patient outcome benchmarks.

但對價值導向照護最大的批評是，鄉村和小型的醫院系統自然會出現較差的結果，因為它們缺乏達成全國病患結果基準所需的資源。

If they can't meet those standards, they receive less federal funding, making it even more challenging for them to reach patient outcome goals.

如果它們無法達到這些標準，就會獲得較少的聯邦資金，這讓它們更難達成病患結果目標。

If implemented inappropriately, value based care could lead to a vicious cycle of the top hospital systems receiving the lion's share of federal funding and smaller programs not receiving the resources they need to offer high value care.

如果實施不當，價值導向照護可能會導致一個惡性循環，頂尖的醫院系統獲得大部分聯邦資金，而小型計畫則無法獲得提供高價值照護所需的資源。

So let's review and compare the differences between these two payment models side by side since this is an understandably complicated topic.

所以，既然這是一個可以理解的複雜話題，我們就來並排檢視和比較這兩種支付模式的差異。

First, the payment model fee for service means providers are paid for each service rendered regardless of outcome or quality.

首先，論量計酬照護的支付模式意味著醫療提供者會因為提供的每項服務而獲得報酬，而與結果或品質無關。

Value based care means providers are reimbursed based on the quality and effectiveness of care provided with incentives tied to patient outcomes.

價值導向照護意味著醫療提供者會根據所提供照護的品質和有效性獲得報銷，獎勵與病患結果掛鉤。

Second, how do these models influence physician behavior?

其次，這些模式如何影響醫師的行為？

Fee for service care may incentivize unnecessary tests, procedures or treatments.

論量計酬照護可能會鼓勵不必要的檢查、處置或治療。

Value based care encourages providers to prioritize preventive care, chronic disease management and patient engagement.

價值導向照護鼓勵醫療提供者優先考慮預防性照護、慢性病管理和病患參與。

However, there's potential for value based care to incentivize physicians to cherry pick healthier patients and neglect more complex cases.

然而，價值導向照護有可能會鼓勵醫師挑選較健康的病患，而忽略較複雜的病例。

Third, how do the models influence cost control?

第三，這些模式如何影響成本控制？

Fee for service care can lead to higher healthcare costs due to overutilization.

論量計酬照護可能因為過度使用而導致醫療成本升高。

Value based care aims to control costs by improving efficiency and focusing on preventive care.

價值導向照護旨在透過提高效率和專注於預防性照護來控制成本。

However, shifting from fee for service to value based care requires a significant overhaul which is both challenging and costly.

然而，從論量計酬轉向價值導向照護需要進行重大改革，這既具挑戰性又成本高昂。

An incredible amount of data along with the technology to analyze this data is required to accurately and effectively measure the value of care.

需要大量的數據以及分析這些數據的技術，才能準確有效地衡量照護的價值。

It's a huge investment that many hospitals do not have the extra resources for.

這是一筆巨大的投資，許多醫院沒有額外的資源來進行。

And lastly, what's the long term impact of both payment models?

最後，這兩種支付模式的長期影響是什麼？

Fee for service care may contribute to unsustainable health care spending and variable quality of care.

論量計酬照護可能會導致不可持續的醫療支出和參差不齊的照護品質。

Value based care is intended to improve overall population health and reduce health care spending in the long term by emphasizing prevention and value.

價值導向照護旨在透過強調預防和價值，來長期改善整體人口健康並降低醫療支出。

So could the US Transition to a value based care system?

那麼，美國有可能轉向價值導向照護系統嗎？

This is the million dollar question on every physician and hospital administrator's mind.

這是每位醫師和醫院管理者心中百萬美元的問題。

While value based care is an exceptionally complicated process, it can be equally as profitable as fee for service care and is better for patients.

雖然價值導向照護是一個極其複雜的過程，但它的獲利能力可以與論量計酬照護相當，而且對病患更好。

There is a strong national push to reduce healthcare spending by stopping unnecessary tests and procedures from being performed.

全國上下都在大力推動減少醫療支出，方法是停止進行不必要的檢查和處置。

Looking to the future, the United States healthcare system is slowly replacing its traditional fee for service care model with value based care care.

展望未來，美國醫療保健系統正緩慢地以價值導向照護取代其傳統的論量計酬照護模式。

These healthcare payment decisions will greatly impact everyone regardless if you are the one providing care or receiving it.

這些醫療支付決策將對每個人產生重大影響，無論您是提供照護者還是接受照護者。

If you want to know more about how these changes are being implemented.

如果您想了解更多關於這些變革的實施方式。

There are dozens of national organizations focused on creating this change.

有數十個國家級組織致力於推動這項變革。

The best example is Choosing Wisely, an international organization that has helped pass legislation to encourage more and more hospitals to switch to value based care models.

最好的例子就是「明智選擇」（Choosing Wisely），這是一個國際組織，協助通過立法鼓勵越來越多的醫院轉向價值導向照護模式。

Linked in the Description no matter the type of medical practice you end up pursuing, research will play a huge role in getting you there.

在說明欄中會提供連結，無論您最終選擇哪種醫療執業方式，研究都將在您達成目標的過程中扮演重要角色。

Elevating your research skills and building your list of publications will open doors for you, period.

提升您的研究技能並累積您的出版品清單，將為您敞開大門，毫無疑問。

And not having adequate research experience will propel other students ahead of you.

而若沒有足夠的研究經驗，其他學生就會超越您。

The Med School Insiders Ultimate Research course has over 75 video modules that distill the tactics and lessons.

Med School Insiders 的終極研究課程包含超過 75 個影片模組，濃縮了各種策略和課程內容。

Our three physician course creators, myself included, learned from earning more than 60 publications and abstracts each each.

我們三位醫師課程創作者，包括我在內，都是透過各自獲得超過 60 篇出版品和摘要的經驗學習而來。

And it's this very research that consistently wowed admissions committees both for medical school and residency.

正是這些研究，持續讓醫學院和住院醫師的申請委員會印象深刻。

Whether you're applying to medical school or residency, we're confident you will find tremendous value.

無論您是申請醫學院還是住院醫師，我們都相信您會發現巨大的價值。

Access the ultimate pre med and medical student Research course in the Description for the next 30 days, use coupon code VALUE20 for 20% off the course.

在說明欄中，您可以在接下來的 30 天內取得終極醫學預科和醫學系學生研究課程，使用優惠代碼 VALUE20 可享課程 8 折優惠。