美国识别和调整不合理医疗服务价格的机制、实践及启示

Mechanism, Practice and Enlightenment of Identifying and Correcting Mis-Valued Services in the US.

建立医疗服务价格动态调整机制是我国医疗服务价格改革的重要目标。该研究深入分析了美国识别和调整不合理医疗服务价格机制及实践经验。同时,对我国当前识别和调整不合理医疗服务价格存在的问题进行了剖析,并提出了建立具有区域约束下的识别和调整不合理医疗服务价格的刚性机制;构建识别和调整不合理医疗服务价格的基本原则及流程工具;以及探索区分医疗服务价格要素及点数化,逐步形成医保总额挂钩的联动机制等政策建议。

Establishing the dynamic adjustment mechanism of medical service price was an important goal of the medical service price reform in China. It deeply analyzed the mechanism and practice of identifying and correcting mis-valued services in the US. Meanwhile, the problems in identifying and correcting mis-valued services in China were analyzed to propose policy suggestions such as a rigid mechanism for identifying and correcting mis-valued services with regional constraints, the basic principles and process tools for identifying and correcting mis-valued services, differentiating medical service prices and the linkage mechanism of the total medical insurance amount.