我国医院结算方式改革进展及其难点突破

The Development and Breakthrough of Settlement MethodReform in Hospitalsin China

本文在总结我国医院结算方式改革和医院"先诊疗,后结算"付费模式进展的基础上,剖析了医院结算方式改革的4个难点,即医院结算方式改革路径选择、结算方式改革所涉及的利益相关者、结算方式如何逐步系统推进、实现结算方式的多样化。由此提出优化结算方式改革试点,积累经验;基于利益相关者角度,多角度考量医院结算政策;因院而异,结合成本核算,推进结算方式多样化;统筹兼顾,部门协调,整体推进医院结算改革。

This paper summarizes reform development of settlement methods and also the development of ＂first treatment and then charge＂ method, analyzes the four most difficult problems we facing of this method ： first is that the reform of settlement method must suit for the social en- vironment of the country, second is that the reform must take every potential stakeholder into consideration; third is that there is no single settlement method that is suitable for the whole country ; fourth is that the reform of settlement method must be systematically developed. With the analysis the paper also gives four suggestions to solve these problems： first is to optimize the pilot program of settlement reform to accumulate experi- ences ; second is try to implement policies take every stakeholder and situations of different hospitals into consideration ; third is to implement different kinds of settlement methods which are suitable for different kinds of hospitals ; fourth is that different departments must coordinate with each other to promote the reform of hospital settlement.