建立以人为本的医疗服务费用管理模式研究  

Establishing the People-oriented Medical Service Cost Management Mode

作　　者：杨玲[1] 叶菁 Yang Ling;Ye Jing(Economics and Management School,Population Resources Environmental Economic Research Center,Wuhan University,430072;Department of Sociology,University of Maryland,Washington,MD20742)

机构地区：[1]武汉大学经济与管理学院/人口·资源·环境经济研究中心,武汉430072 [2]马里兰大学社会学系,华盛顿MD20742

出　　处：《中国医疗保险》2022年第2期32-36,共5页China Health Insurance

基　　金：国家社会科学基金项目“以人为本的医疗服务控费机制研究”(19BGL227)。

摘　　要：党的十八大以来,全民医疗保障制度改革持续推进,在破解看病难、看病贵问题上取得了突破性进展。但随着医疗费用快速增长,制度可持续性面临严峻挑战。如何增强医保对医药服务领域的激励约束作用,通过更有效率的医保支付让群众获得优质医药服务,是我国医保工作的一项重要课题。现行费用管理主要以医疗机构为中心,对患者关注有限,其与患者对健康产出期待之间的天然矛盾导致管理难以持续有效。本文指出,控制医疗服务费用快速增长应以人(患者)为中心,从患者需求出发,以提升患者健康价值为目标,在对患者的医疗服务成本和健康产出进行科学测算后,医保支付方应根据实际服务绩效对各家医疗机构进行支付,以此促使医疗机构通过优化服务提高资源使用效率,实现费用管理与患者健康价值提升的双赢。Since the 18th National Congress of the Communist Party of China,the reform of national healthcare security system has continued to advance,and breakthrough progress was made in solving the problems of difficult and expensive medical treatment.However,the sustainability of the healthcare security system is facing severe challenges with the rapid growth of health expenditure.The important issues facing by China’s healthcare security are how to enhance the incentive and restraint role in the field of medical services,and how to make people obtain high-quality health services through more effective healthcare security payment.Actually,the current cost management mechanism is centered on medical institutions and pays limited attention to patients which leads to the fragmentation of related reform measures.The contradiction between cost management and patient health output makes it difficult to form a continuous and effective cost management mechanism.This article believes that health service cost management should be centered on people(patients),which means starting from the needs of patients,aiming at improving the value of patients.And on the basis of patient-oriented cost accounting and health output measurement,the payer of healthcare security shall pay each medical institution according to the actual service performance,so as to improve resource utilization efficiency and achieve a win-win situation for cost management and patient value enhancement.

关 键 词：以人为本 费用管理 TDABC 健康产出 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]