不同支付方式促进卫生服务整合的作用分析

Analysis on the Effects of Different Payment in the Achieving of Health Care Integration

支付方式改革能够推动医联体、分级诊疗等机构间的服务协作关系的建立,DRGs与按人头付费能够带来服务质量的提升与成本降低。不同的支付方式对机构间的协作效应不同,医保的统筹层次与其带来的服务组织整合的程度一一对应,按项目付费只能够影响个体医生的行为,而按人头预付整合的服务供给体系更容易形成,随着医保服务统筹的层次越高,在其作用下能够实现的组织整合程度也就越高,同时不同统筹层次下的评估重点也有所差异。所以,应针对不同的改革需求,选择相应的支付方式,同时也要考虑医保的支付效率与改革的难易程度。

Payment reform could promote the establishment of service cooperative relationship between the hospital alliance and the hierarchical diagnosis and treatment. DRGs and capitation could heighten the quality of service and lower the cost. The hospitals ＇ cooperative effects were different under different payment methods. There was a one-to-one relationship between the pooling level of medical insurance and its degree of service integration. The fee for service could only influence the individual doctors＇ behaviors. hut the capitation integrated service supply system was easier to form. The higher pooling level of medical insurance service was, the higher the organization integration level could achieve under the function, Meanwhile, the assessment emphasis was different under dif- ferent pooling level. Therefore, according to different reform demand, it needed to select relevant payment and consider the payment ef- ficiency of medical insurance and the complexity of reform.