基于价值的医保支付概念演变、国外探索与中国框架

Value-Based Payment for Medical Insurance:Concept Evolution,Foreign Exploration and China Framework

目的:探讨基于价值的医保支付的内涵,并为我国基于价值的医保支付设计提供参考。方法:通过归纳基于价值医保支付的概念演变,并分析英国和美国基于价值的医保支付的改革历程,结合我国医保改革目标提出具体建议。结果:基于价值的医保支付产生于卫生控费改革过程中,经历了从成本-效益分析的单一经济价值追求拓展至重视健康绩效、患者体验、医生职业发展等多元价值的追求过程。结论:构建了中国基于价值的医保支付框架并提出相应实践举措。

Objective:To study value-based medical insurance payments,provide decision-making references for the value-based health insurance payment framework in China.Methods:It summarizes the evolution of the concept of value-based medical insurance payment,analyzes the reform process of value-based medical insurance payment in the UK and the US,and puts forward specific suggestions combined with the objectives of China ’s medical insurance reform.Results:During the reform of health cost control worldwide,it is found that the concept has gradually expanded from the single economic value pursuit of cost-benefit analysis to the multi-value pursuit of health performance,patient experience and doctor career development.Conclusion:It constructs the value-based medical insurance payment framework in China and puts forward the corresponding practical measures.