英、德医保“人头费”制度及经验借鉴

Study on the Experience of “Capitation Fee” System of British and Germany

本文分析了英德"人头费"制度的主要特征,认为强制基层首诊、以私立为主的初级卫生保健体系和自由执业的全科医生制度是"人头费"制度实施的基础。以英德经验为鉴,根据我国医改现状,提出可在基层卫生机构采取"从门诊到住院"分步实施按人头付费,改革公立初级卫生保健运营机制和医生职业管理制度,重构初级卫生服务体系,完善财政、医保等相关配套制度。

This paper analyzed the main features of ＂capitation fee＂ system of British and Germany, and concluded that obliged primary diagnosis, private-dominated primary health care system and free-practice of GP are the base of their ＂capitation fee＂ system. According to the experience of British and Germany, and based on the reality of China, we suggested that the ＂capitation fee＂ system should be established step by step from ＂inpatient to outpatient＂, the govemment-owned primary health care operation mechanism and doctor career management system should be reformed, the primary health care system should be rebuilt, and related supporting system such as public financial policies and health insurance system should be improved.