支付方式与卫生服务体系整合:一个国内外实践与研究进展评述

发布时间：2019-03-20 20:30

【摘要】：目的:从整合体系构建的视角比较后付制、预付制和混合支付方式在理论和实践中的利弊。方法:结合理论分析和实地调研,对整合体系改革中配套支付方式改革案例进行评析。根据控费对象对现行支付方式进行分类;从服务协同、质量保障、费用控制和流向调节四个方面,对不同混合支付方式对整合的作用进行比较。结果:支付方式可分为按单机构、多机构、服务单元和诊疗过程控费四类;集团总额预付制促进整合作用最好,按病种和按人头付费次之,按项目付费和单机构总额控费对整合起负向作用。结论:基于绩效的集团总额预付制和基于多机构协作的临床路径两种混合支付方式,能较好兼顾费用控制和供方协作等多重目标,是未来整合型服务体系改革中支付方式改革的方向。
[Abstract]:Objective: To compare the advantages and disadvantages of payment system, prepayment system and mixed payment method in theory and practice from the angle of view of the whole system. Methods: Combined with the theoretical analysis and the field investigation, the paper analyzes the case of matching payment method in the reform of the whole system. The current payment method is classified according to the cost control object, and the effect of different mixed payment methods is compared with the four aspects of service coordination, quality assurance, cost control and flow direction adjustment. Results: The payment method can be divided into four categories: single-agency, multi-agency, service unit and medical-treatment process. The group's total pre-payment system is the best to promote the whole-in-one action. Conclusion: The two mixed payment methods based on performance-based total prepayment system and multi-agency collaboration can better balance the multiple goals such as cost control and supplier collaboration, which is the direction of the reform of the payment method in the reform of the whole service system in the future.
【作者单位】：中国药科大学国际医药商学院;遵义医学院管理学院;华中科技大学同济医学院医药卫生管理学院;
【基金】：中华医学基金会资助项目(11-069)
【分类号】：R1

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