国际供方支付制度改革的经验及对我国未来支付制度改革的启示

Opinions on International Experiences and Their Implication on Future Provider Payment Reform in China

国际支付制度改革的趋势是以预付制为目标,以打包付费为形式,综合性的混合型支付制度改革,且是逐步过渡,需要有相应的配套制度才能在改革的多目标之间达到一种平衡。下一步推行支付制度改革的核心就是开展不同形式的打包付费。全国差异较大,不能强求用一种或者多种支付方式,而是需要在国家层面做出不同的规范,规定选择不同支付方式的使用原则和适宜条件,确定医疗服务机构和相应服务范围,制定支付标准,推荐给地方,各地根据不同的情况自行选择。本文从国际视角出发,针对供方支付制度的概念、发展变迁、激励机制、风险水平及其与医疗服务监管的关系等分别进行了阐述。

International experience shows that the payment reform have taken a pre-pay system as its target.The payment is a multiple mixed method with bundled services,and its reform is a gradual transition,and needs corresponding accessory institutions to make a balance among the multiple goals.In China,the core of further payment reform is to carry out different payment methods with prospective bundled services.No one or multiple uniform payment methods could be importunely used because the conditions of regions in China vary remarkably.It is necessary to make different criteria in the state level,providing selection of different payment methods by defining beneficiaries,service package,and payment standards.It is recommended that local authorities could choose the payment system according to their own circumstances.This paper describes the concept,evolvement,incentives of provider payment system,level of risk and its relationship with the supervision of medical services.