不合理医疗费用控制中外实施策略对比研究

Comparative study on Chinese and foreign implementation strategy in irrational medical expenditure control

与世界上大多数国家一样,我们同样存在卫生总费用增幅过快、卫生事业投入不足及卫生资源利用效率极差等医疗费用控制问题。通过对国际发达国家的不合理医疗费用控制策略对比研究发现,政府管理与市场机制结合运用、外部监督与内部约束结合运用、费用分担与风险共担结合运用、创新管理手段与强制性的法律保障结合运用是他们采用的有效方法。结合中国的实际情况,我们认为完善基本医疗体系、平衡区域医疗资源,在按病种付费的同时衔接三大医保实现医疗保险“打包服务”,采用药品参考价格制度并保障药事服务收费合理,医疗信息公开等方法,将是中国实现不合理医疗费用控制的主要路径。

The same with most countries of the world,there are problems in too rapid total expenditure on health,insufficient health investigation and extremely bad health resource utilization rate in China.Through the comparison of irrational medical expense control strategy in developed countries,it is found that the useful methods include the organic application of government management and market mechanism,application of external supervision and interior constraint,the combined application of expense sharing and risk sharing,and innovative management method and the restricted legal safeguard.Through the combination of Chinese actual situation,it is suggested to perfect basic medical system,balance regional medical resource,connect“package service”of medical insurance through combining with the three medical insurances by payment per disease,adopt medical reference price system,insure reasonable pharmaceutical affairs service payment,and disclose medical information,etc.There are the main pathways to solve irrational medical expense in China.