基于价值的医保支付概念演变、国外探索与中国框架  

Value-Based Payment for Medical Insurance:Concept Evolution,Foreign Exploration and China Framework

作　　者：张素 王红波 宫佳宁 ZHANG Su;WANG Hong-bo;GONG Jia-ning(School of Business,Shanxi Technology and Business College,Taiyuan,030062,China;不详)

机构地区：[1]山西工商学院商学院,太原030062 [2]中国人民大学公共管理学院,北京100872 [3]中华女子学院女性学系,北京100101

出　　处：《中国卫生经济》2022年第3期30-35,共6页Chinese Health Economics

基　　金：中国人民大学2021年度拔尖创新人才培育资助计划成果。

摘　　要：目的:探讨基于价值的医保支付的内涵,并为我国基于价值的医保支付设计提供参考。方法:通过归纳基于价值医保支付的概念演变,并分析英国和美国基于价值的医保支付的改革历程,结合我国医保改革目标提出具体建议。结果:基于价值的医保支付产生于卫生控费改革过程中,经历了从成本-效益分析的单一经济价值追求拓展至重视健康绩效、患者体验、医生职业发展等多元价值的追求过程。结论:构建了中国基于价值的医保支付框架并提出相应实践举措。Objective:To study value-based medical insurance payments,provide decision-making references for the value-based health insurance payment framework in China.Methods:It summarizes the evolution of the concept of value-based medical insurance payment,analyzes the reform process of value-based medical insurance payment in the UK and the US,and puts forward specific suggestions combined with the objectives of China ’s medical insurance reform.Results:During the reform of health cost control worldwide,it is found that the concept has gradually expanded from the single economic value pursuit of cost-benefit analysis to the multi-value pursuit of health performance,patient experience and doctor career development.Conclusion:It constructs the value-based medical insurance payment framework in China and puts forward the corresponding practical measures.

关 键 词：医保支付 按绩效支付 按价值付费 价值医疗 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F840.613[经济管理—保险]