医疗服务供方支付制度改革的挑战与建议

Challenges and suggestions on reform of provider payment system of medical services

简要回顾了我国医疗服务供方支付方式改革进展,分析了目前医疗服务支付体系面临的主要挑战,包括: 医疗服务各方职责关系不明确、缺乏系统的质量标准和质量改进机制以及缺乏对供方的有效激励与引导等。指出单一的支付方式改革无法解决系统问题,必须通过开展系统、综合性改革才能在支付改革领域取得突破; 建议推动经办机构成为战略服务购买者,通过需方筹资改善服务绩效,完善支付制度作为医疗保险战略采购政策工具的功能。

This paper reviewed the progress and results of provider payment reform of medical service in China and analyzed the main challenges of payment system, including unclear role of various stakeholders in medical serv- ices, lack of quality standards and quality improvement mechanisms, insufficient incentive and guidance on the sup- ply side. This paper clearly points out that reform on payment method alone cannot solve the systematic problems. Breakthroughs in the reform can only be achieved through systematic and overall reform. The paper also proposes en- couraging health insurance agencies to become strategic purchasers of health services, improving service performance by demand side oriented financing, and improving payment system＇ s function as the policy tool of strategic purchase of medical services.