支付方式改革推动医疗机构转变运行机制的作用和条件分析  

The Effect and Conditions for Medical Payment Reform in Driving Healthcare Providers to Change Operational Mechanism

作　　者：顾雪非 向国春 刘小青[3] 李婷婷 徐楠 Gu Xuefei;Xiang Guochun;Liu Xiaoqing;Li Tingting;Xu Nan(China National Health Development Research Center,Beijing,100191;School of Health Services Management,Southern Medical University,Guangzhou,510515;School of Economics,Tianjin University of Finance and Economics,Tianjin,300222)

机构地区：[1]国家卫生计生委卫生发展研究中心,北京100191 [2]南方医科大学卫生管理学院,广州510515 [3]天津财经大学经济学院,天津300222

出　　处：《中国医疗保险》2018年第4期22-26,共5页China Health Insurance

摘　　要：随着医保资金成为我国医疗机构的主要收入来源,医保支付方式的激励作用将对医疗机构的运行机制发生重要作用。以成本-收益因素的考量为核心,从按项目付费向总额预算付费转变的支付方式将促使医疗机构关注成本、减少不必要的服务、提高服务效率,推动医疗机构从单纯关注医疗服务的数量转向关注医疗服务的价值。审视目前的改革进程,我国支付方式改革欲实现对医疗机构的有效激励,还需要借助诸如赋予医院更多自主权、加强多重机制协同性、推动多元支付方式组合向关注"价值"方向改进、提升支付方式技术水平、加快分级诊疗改革进程等基础条件的支持与推动。只有实施全面和系统的支付方式改革,才能实现助推医疗机构转变运行机制的作用,"三医联动"改革才更具活力。Motivation of medical insurance payment will play an important role in promoting healthcare providers to change their operational mechanism,especially when medical insurance funding has become a main revenue source for them.Focusing on cost-benefi t factors and turning from retrospective payment to prospective payment,medical payment mode can drive healthcare providers to pay more attention to costs,reduce unnecessary services,improve effi ciency,and turn their focus from health service quantities to health care value.As response to China’s health system reform,medical payment reform requires the support of other institutional conditions,such as endowing more autonomy to hospitals,enhancing synergy of multiple mechanisms,pushing forward the improvement of medical payment from multiplex combination to concerning“value”,upgrading payment technics,and speeding up the reform of grading diagnosis and treatment.The operational mechanism of healthcare providers could be improved,only with comprehensive and systematical medical payment reform,so that the co-development of medical insurance,health care,and drug industry will get much more energy.

关 键 词：医疗保险 支付方式改革 医疗机构运行机制 价值 “三医联动” 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]