付费方式、经办机制和医疗体制联动改革的理论基础

Study on the Theory of the Linkage Reform of Payment Method,the Handling Mechanism and the Medical System

本文在分析米尔顿·弗里德曼的"花钱矩阵"的基础上,提出人民群众的花钱办事理论。人民群众的花钱办事理论是新三医联动模式的理论基础。人民群众的花钱办事理论包括卖方的花钱办事理论和买方的花钱办事理论。卖方的花钱办事理论对医疗服务体制机制改革具有重要的指导意义:要让医疗机构自觉控制医疗费用,关键是将医疗机构花"人家"钱的机制转变为花"自家"钱的机制;要让医疗机构自觉保障医疗质量,关键是将医疗机构办"人家"事的机制转变为办"自家"事的机制。买方的花钱办事理论对医疗保险付费方式和经办机制改革具有重要的指导意义:要让经办机构积极控制医疗费用,关键是将经办机构花"人家"钱的机制转变为花"自家"钱的机制;要让经办机构积极保障医疗质量,关键是将经办机构办"人家"事的机制转变为办"自家"事的机制。

Based on analysis of ＂cost matrix theory＂ by Milton Friedman, this paper puts forward the theory of ＂peoplei spend - money and handle - affairs＂, including ＂seller＇ s spend - money and handle - affairs＂ theory and ＂buyer＇ s spend - money and handle - affairs＂ theory. The ＂people＇s spend - money and handle - affairs＂ theory is the theoretical foundation of the New Tripartite System Reform Model. The ＂seller＇ s spend - money and handle - affairs＂ theory has important guiding significance on the medical service system reform, namely if we want to allow medical institutions to consciously control medical costs, the key is to transform the mechanism of spending ＂others＇ ＂ money to the mechanism of spending ＂own＂ money, and if we want to allow medical institutions to consciously ensure the medical quality, the key is to transform the mechanism of handling ＂others＇ ＂ affairs to the mechanism of handling ＂own＂ affairs. The ＂buyer＇ s spend - money and handle - affairs＂ theory has important guiding significance on the reform of payment model and handling mechanism, namely if we want to allow handling institution to actively control medical COSTS, the key is to transform the mechanism of spending ＂others＇ ＂ money to the mechanism of spending ＂own＂ money, and if we want to allow handling institutions to actively ensure the medical quality, thekey is to transform the mechanism of handling ＂others＇ ＂ affairs to the mechanism of handling ＂own＂ affairs.