基于选择行为激励的医疗服务价格改革初探  

Preliminary exploration of medical service price reform based on choice behavior motivation

作　　者：章平 林杰 王壮飞 陈民[4] 张小春 徐青 Zhang Ping;Lin Jie;Wang Zhuangfei;Chen Min;Zhang Xiaochun;Xu Qing(School of Public Administration,Zhejiang Universtiy,Hangzhou 310058,China;Hangzhou Medical College,Hangzhou 311399,China;Health Commission of Zhejiang Province,Hangzhou 310006,China;Municipal Hospital of Rui′an,Wenzhou 325299,China;Developement and Reform Bureau of Rui′an City,Wenzhou 325299,China;School of Public Health of Hangzhou Normal University,Hangzhou 311121,China)

机构地区：[1]浙江大学公共管理学院,杭州310058 [2]杭州医学院,杭州311399 [3]浙江省卫生健康委员会,杭州310006 [4]瑞安市人民医院,温州325299 [5]瑞安市发展改革局,温州325299 [6]杭州师范大学公共卫生学院,杭州311121

出　　处：《中华医院管理杂志》2022年第3期168-172,共5页Chinese Journal of Hospital Administration

基　　金：浙江省软科学研究计划(2021C35106,2018C35009)。

摘　　要：医疗服务价格形成机制是卫生经济学的底层制度,深刻影响医生的诊疗行为和医院的运行模式。浙江省温州市瑞安市基于医院采购环节的药品耗材品规选择和使用环节的医生合理诊疗行为腾出药品耗材费用空间,将腾出空间的68%用于提高医疗服务价格,选择护理、中医、诊察类等248个成本倒挂明显的医疗服务项目,按照约定的腾空间额度来确定调价幅度;并应用支付宝信用机制同步实施"腾空间调结构",以解决医疗、医保博弈问题,拓宽医疗服务价格改革"平移补偿法"的路径,并与医保支付方式改革产生政策叠加联动效应,取得较好成效。Medical service pricing system is the basic system of health economics,which has a profound impact on physicians′medical behavior and the running mode of hospital.Rui′an City,Wenzhou City,Zhejiang Province,freed up the cost space of drug and consumables based on the reasonable diagnosis and treatment behavior of doctors and selection of drug and consumables in the hospital procurement link.68%of the free space was used to improve the price of medical services.248 medical service items with obvious cost inversion were selected,such as nursing,traditional Chinese medicine,diagnosis,etc.,and the price adjustment range was determined according to the agreed free space limit.Meanwhile,the credit mechanism of Alipay was applied to synchronously implement"vacating space and adjusting structure",so as to solve the game problem between medical treatment and medical insurance,broaden the path of the"translation compensation method"of medical service price reform,and produce policy superposition and linkage effect with the reform of medical insurance payment mode.

关 键 词：医疗服务价格 医生诊疗行为 按项目收费 使用环节腾空间 医药联动 

分 类 号：R197.1[医药卫生—卫生事业管理]