支付方式与卫生服务体系整合:一个国内外实践与研究进展评述  

Payment and Healthcare Service System Integration: Commentary on the International and Domestic Practice and Research Progress

作　　者：唐文熙[1] 魏来[2] 张亮[3] 

机构地区：[1]中国药科大学国际医药商学院,南京211198 [2]遵义医学院管理学院,贵州遵义563003 [3]华中科技大学同济医学院医药卫生管理学院,武汉430030

出　　处：《中国卫生经济》2016年第5期32-34,共3页Chinese Health Economics

基　　金：中华医学基金会资助项目(11-069)

摘　　要：目的:从整合体系构建的视角比较后付制、预付制和混合支付方式在理论和实践中的利弊。方法:结合理论分析和实地调研,对整合体系改革中配套支付方式改革案例进行评析。根据控费对象对现行支付方式进行分类;从服务协同、质量保障、费用控制和流向调节四个方面,对不同混合支付方式对整合的作用进行比较。结果:支付方式可分为按单机构、多机构、服务单元和诊疗过程控费四类;集团总额预付制促进整合作用最好,按病种和按人头付费次之,按项目付费和单机构总额控费对整合起负向作用。结论:基于绩效的集团总额预付制和基于多机构协作的临床路径两种混合支付方式,能较好兼顾费用控制和供方协作等多重目标,是未来整合型服务体系改革中支付方式改革的方向。Objective：To compare the advantages and disadvantages of post-pay system, pre-pay system and blending paymentmodes based on theory and practice from the view of establishing integration system.Methods：Theoretical analysis and field researchwere combined to analyze the case of complementary approaches for integration system reform. The current payment mode were classified based on the object of cost control. The impact of different blending payment modes on the integration were compared from service synergy, quality security, cost control and flow regulation.Results：The payment method could be categorized into single institution, multi-institution, service unit and cost control on treatment process. The global budget could promote the integration function, followed by pay for single disease and pay by capitation. Pay by project and single institution global cost control had negative function onthe integration.Conclusion：Blending payment methods including the global budget based on performance and the clinical pate basedmulti-institution collaboration could help to achieve goals including cost control and supplier collaboration, which would be the direction for payment reform in the future integrated service system reform.

关 键 词：整合型服务体系 混合支付方式 责任医疗组织 集团总额预付 多机构协作 

分 类 号：R1[医药卫生—公共卫生与预防医学]