消除百姓看病贵及其担忧:“总额预算+按服务单元付费”组合支付方式预期效果之一  

Expected effects of the mixed payment of"Global budget and Service unit"(Ⅰ):eliminating the phenomenon of"Seeing a doctor is expensive"and concerns of the public

作　　者：王颖[1] 苌凤水[1] 励晓红[1] 吕军[1] 孙梅[1] 朱道立[2] 陈英耀[3] 郝模[1] 

机构地区：[1]复旦大学卫生发展战略研究中心,上海200032 [2]同济大学经济与管理学院,上海200092 [3]复旦大学公共卫生学院,上海200032

出　　处：《中国卫生资源》2011年第1期16-17,共2页Chinese Health Resources

基　　金：国家自然科学基金重点项目基金资助;项目编号:70733002;"长江学者特聘教授"项目基金资助;教育部2009年度创新团队项目基金资助;项目编号:IRT0912;国家社会科学青年基金资助项目;项目编号:08CZZ022

摘　　要：为论证"总额预算+按服务单元付费"组合支付方式改革对消除百姓看病贵问题的效果,文章利用全国财务年报和中国卫生统计年鉴进行定量模拟测算并结合意向论证,结果表明:(1)组合支付方式以"～口价"的形式消除了半数(50.4%)原有看病贵;(2)80%的人分担了20%人群的高额费用风险,消除了看病贵感觉的基础;(3)在单元付费标准基础上,结合城镇职工医疗保险的平均60-70%的报销比例,百姓去市级医院就诊一次自费仅花53.5元,医疗费用负担大幅减轻,看病应该不贵;(4)如果再加上政府对医疗机构的适宜投入,即使以1:2的比例匡算,如果政府保障人员经费,百姓的次费负担可以下降10.4～20.9元,门急诊次均费用仅为32.6～43.1元;如保障基本建设和专业设备等经费后,次费再下降15.6～31.4元,仅为22.1～37.9元;而如果政府全包两项投入,看病直至免费!如此,百姓没理由再感到看病贵。To demonstrate ＂Gobal budget and Service unit＂ reform can eliminate the phenomenon of ＂Seeing a doctor is expensive＂ and concerns of the public,the paper analysed the expected effect of the mixed payment reform on folks by means of quantitative analysis and intent survey.The result indicated：（1） The fixed price of service unit can eliminate half concerns of the public of medical expenditure;（2） Since the high medical expenditure that 20% of the people suffered from can be shared by 80%of the people with the payment transformed from the ＂ fee-for-service＂ to ＂fee-for-service unit＂,there are no more risk of high medical expenditure;（3） Combined with medical insurance, the expenditure per visit can be cut off to 53.5 yuan per unit.（4） In addition,if government can invest more subsidy in hospitals＇ personnel cost,the expenditure can decline to 32.6～43.1yuan;if in hospitals＇ infrastructure and equipment,that will be 22.1～37.9 yuan.So perfecting the government financing,＂Seeing a doctor is expensive＂ can be eradicated.

关 键 词：总额预算 按服务单元付费 次均费用 

分 类 号：R197[医药卫生—卫生事业管理]