医保支付和监管与医疗服务绩效评价协同机制探讨  

Exploring a Synergy Mechanism in Payment, Supervision of Medical Insurance and Performance Evaluation of Medical Services

作　　者：雷鹏[1,2,3] 王克利[1,4] 吴擢春[1,2] 

机构地区：[1]复旦大学公共卫生学院,上海200032 [2]公共卫生安全教育部重点实验室,上海200032 [3]上海市徐汇区人力资源和社会保障局,上海200030 [4]上海市徐汇区卫生和计划生育委员会,上海200030

出　　处：《中国医疗保险》2014年第12期9-11,共3页China Health Insurance

摘　　要：本文认为公立医院改革必须辅之以医疗保险支付和监管与医疗服务绩效评价协同机制,扭转被动付费的传统角色。同时,医疗机构必须优化完善绩效管理,在战略规划、财务管理、业务流程、薪酬分配、患者满意度、组织成长、信息管理等方面进行适应性调整。The public hospitals reforms cannot obtain prospective effects without the support from supervision system. The authors believe that the synergy in payment, supervision of medical insurance and performance evaluation of medical services is necessary for the public hospitals reforms by changing payer＇s traditional passive role as a powerless accountant. Meanwhile, the care providers should improve their capacity of performance management and adjust to the reform in terms of strategic planning, financial management, service procedure, income distribution, patient satisfaction, organizational development and information technologies, etc.

关 键 词：基本医疗保险 支付方式 监管体系 医疗服务绩效评价 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]