医保支付方式由后付制向预付制改革对供方医疗服务行为影响的机制和发展路径  

The mechanism and pathway of the health insurance payment reform from retrospective to prospective mode on the medical provider's behavior

作　　者：韩优莉[1] HAN You-li(School of Public Health, Capital Medical University, Beijing 100069, China)

机构地区：[1]首都医科大学公共卫生学院,北京100069

出　　处：《中国卫生政策研究》2021年第3期21-27,共7页Chinese Journal of Health Policy

基　　金：国家自然科学基金面上项目(71774113)。

摘　　要：全民医保制度下,支付方式提供了影响供方医疗服务行为的手段,成为调节卫生资源配置的重要杠杆。医保支付方式由后付制向预付制的改革,通过财务风险的转移调整对医疗机构和医生行为的激励,控制供方诱导需求行为带来的费用上涨,成为医疗保险制度改革的重要方向。但其发挥作用的基础是医疗服务提供方对支付方式的反应。医疗服务目标的多维性、医疗机构内部激励机制、管理者和医生的行为偏好都会影响改革的作用机制和强度。本文结合中国实际分析了后付制向预付制改革的作用机制和影响因素,并提出建立健康价值引导的支付方式,施行混合支付方式的策略,以及注重间接激励机制下医院管理者和医生参与的发展路径。Under the universal health insurance coverage,the payment mode provides a means to influence the behavior of healthcare service providers and has become an important lever for the adjustment of health resources allocation mechanisms.During the reform from retrospective payment to prospective mode,the adjustment of incentive mechanisms for healthcare service providers'behavior and the control of cost increase caused by the supplier-induced services has become an important direction for the comprehensive reform of health insurance payment system.However,the effect of this reform depends on medical service providers'response to payment methods.Altogether,the multidimensional nature of medical service goals,hospital's incentive policy,and the managers'and physicians'behavioral preferences affect the effectiveness of the reform of payment modes.This article analyzed the reform mechanism and its influencing factors,and proposes the development pathway for the establishment of value-based payment method reforms,choosing mixed payment methods,and inducing hospital managers and physicians'involvement in the reform under indirect incentive mechanisms.

关 键 词：医疗保险 支付方式 供方医疗服务行为 路径 

分 类 号：R197[医药卫生—卫生事业管理]