彻底扭转医疗机构扭曲的补偿机制:“总额预算+按服务单元付费”组合支付方式预期效果之二  

Expected effects of the mixed payment of"Global budget and Service unit"(Ⅱ):completely reversing the distorted reimbursement mechanism of hospitals

作　　者：吕军[1] 王颖[1] 孙梅[1] 励晓红[1] 苌凤水[1] 高解春 汤善健[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]上海申康医院发展中心,上海200041 [3]复旦大学数学科学学院,上海200433

出　　处：《中国卫生资源》2011年第1期23-24,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

摘　　要：为论证"总额预算+按服务单元付费"组合支付方式对扭转医疗机构补偿机制的效果,基于支付方式的设计原理推导,利用全国卫生财务年报资料进行定量模拟测算,同时结合医疗卫生服务管理者、组织者、提供者的意向调查进行分析,结果显示:组合支付方式下,总收入空间固定,为追求收益最大化,医疗机构必然通过"少开点药、少开贵药"、"少做点检查、少做高精尖检查"等方式增加收益;按照医疗机构追求购买价廉质优药、同类药中低价药替代高价药、尽可能以常规项目替代高精尖项目估算,以2008年为例,医疗机构至少净收益(未计人力成本)4 235.0～4 547.4亿元,约占业务总收入的51.8%～55.6%。由此医务人员人均可增加年收入约5.1～5.6万元,从而实现收入"由灰转白",在经济地位得以提升的前提下,执业环境得到改善。最终,医疗机构逐渐步入"成本最小化、收益最大化"内涵式发展的良性循环。In order to demonstrate the effect of reversing the reimbursement mechanism of hospitals in the environment of ＂Global budget and Service unit＂ mixed payment,based on the design principle of payment,the National Health Financing Report data and the intention survey of health service managers,organizers,providers,this paper discovered that under this mixed payment,the total revenue space is fixed.To pursue revenue maximization, the hospitals need adopt the way ＂less prescription drugs,less expensive drugs＂,＂less examinations,less sophisticated examinations＂ to increase revenues.In accordance with purchasing the lowest price drugs,replacing expensive drugs with cheap drugs within the same kind,replacing sophisticated examinations with conventional examinations, all the hospitals nationwide could increase revenues by at least 423.5 to 454.7 billion yuan（without considering the personnel cost） in 2008,accounting for 51.8 to 55.6 percent of total operating revenue.Medical practitioners could increase their incomes by 51.0 to 56.0 thousand yuan per capital so that their economic status and working environment could be improved.Eventually,the hospitals could gradually achieve the ＂ cost minimization,revenue maximization＂ connotative development pattern.

关 键 词：总额预算 按服务单元付费 医疗机构 补偿机制 

分 类 号：R197[医药卫生—卫生事业管理]