公费医疗门诊项目实行“按人头付费”的效果评价

The Effectiveness Evaluation of Capitation in Outpatience Items of Government Employee' s Insurance System

1998年,上海市普陀区医疗保险办公室改革公费医疗支付方式,对门诊项目实行按人头付费。本文就改革实施一年来公费医疗费用发生情况作一分析,对按人头付费方式实施效果进行评估,得出以下结论:该支付方式较为有效地降低了医疗费用的增长幅度,减少了浪费;对促进医院加强内部管理,转变经营策略,重视医疗成本控制,提高卫生资源的利用效率起到了积极的作用。同时提出,要注意纠正个别医疗机构控制费用方法简单化的偏差,要考虑人群年龄结构因素对医疗费用的影响,适当调整付费标准,以避免医疗机构在承担费用支出方面出现畸轻畸重的问题。

Since 1998, Government Employee s Insurance Office in Putuo district of Shanghai has launched the reform of governmental medical payment ways. The study aimed to assess the effectiveness of capitation and has drawn the conclusions that such payment way has decreased effectively the speed of medical expenditure growth and controlled the waste. It plays active roles in enhancing internal hospital management, changing management statistics, controlling medical cost and promoting utilizarion efficiency of health resources. In addition, attentions must he paid to as follows: we must correct the mistake of simplifying the way of controlling medical expenditure, and consider the influence of age construction on medical expenditure, and properly adjust the standard of payment. The research can grearly make medical institutions avoid too low or too high expenditures.