英国全科医师支付方式的改革与发展趋势

Reform and Development of British General Practitioner and Payment Pattern

基于对英国全科医师发展过程及其付费系统改革的历史概述,系统介绍不同支付方式对全科医师行为的影响。主要的付费方式包括月薪、按总额付费、按服务量付费,达标支付或按绩效支付;其中,按绩效支付逐渐成为支付改革的"新宠",因为该方式直接将医师的报酬与其服务绩效紧密联系起来。结合理论分析和实证研究,着重比较了按绩效支付、达标支付和按服务量付费。这些研究对我国发展社区卫生服务,以及实施按绩效支付等措施具有借鉴作用。

Based on a historical overview of UK General Practitioners（GPs）and GP payment system reforms, this article provides a systematic review of the impact of different payment methods, namely, salary, capitation, fee-for-se4rviee （FFS） , and target payment or pay-for-performance（P4P）. The P4P, which establishes a firm and direct link between health professionals＇ payment and performance, has gradually become a popular topic in the payment reform agenda; hence this article sets its focus on the comparison of P4P, target payment, and the FFS. The empirical evidence obtained from the UK GP payment system reforms is highly valuable to the current health care system reform in China. In particular, the UK experience offers important lessons to the political issues in relation to the development of community health care services, the management and rcimburse4ment of community heahhcare providers.