从改变支付方式入手,求得医改的突破(2)：析“总额预算＋按服务单元付费”组合支付方式

To explore a breakthrough of health reform in China through changing payment(Ⅱ):analysis of"Global budget and Service unit"mixed payment

为明确"总额预算+按服务单元付费"组合支付方式对实现医改突破的作用,研究依据支付方式的基本原理推导,并利用医疗卫生服务管理者、组织者、提供者和需方四方意向调查数据,分析论证了该组合支付方式下的6大预期效果:(1)消除看病贵感觉,百姓得到实惠;(2)完善医疗机构补偿机制;(3)消除药品产、销、购、用四方问题;(4)确保医疗费用与社会经济发展同步;(5)为医保收支平衡提供稳定的环境;(6)政府便于监管,易于操作。可以在短期内实现温总理提出的"让老百姓得到实惠,让医务人员受到鼓舞,让监管人员易于掌握"。虽然该组合支付方式也可能带来新问题,但是相对成效,这些问题微不足道并且可通过配套措施得以解决。

To demonstrate the effect of ＂Global budget and Service unit＂ on health reform in China,qualitative analysis of the payment and quantitative survey of intention were used.The paper discovered that with the mixed payment,6 main expected effects were to bring about,such as the feeling of ＂ Seeing a doctor is expensive＂ being eliminated and benefiting the public truly,the incomplete reimbursement mechanism of hospitals being improved,eliminating the problems of production,distribution,purchasing,using to maintain good order in pharmaceutical market, keeping the growth of medical expenditure in line with the social economic development,providing a balanced environment between financing and expenditures for insurance fund,and the Government＇ s easy regulating and operating. In a word,under the mixed payment,＂ common people are benefited,health care providers are encouraged and regulators can conduct easily＂,which Premier Wen put forward clearly could be realized.Of course,there were some new and unavoidable problems.Since these problems were to be resolved by corresponding measures,they were so insignificant.