我国医疗卫生服务绩效评价:回顾、问题与展望

Performance Evaluation of Health Care Services in China:Review,Issues and Prospects

医疗卫生服务绩效评价是调动医务人员工作积极性的关键,影响医疗改革的进程。基于绩效评价的视角,回顾新中国成立以来医疗卫生改革经历的计划经济时期、改革开放初的“断裂期”、经济转型探索期、医疗卫生市场化、反思和新医改六个阶段。剖析收支结余法和基于资源相对价值量表的绩效评价原理和激励机制,从中总结出医疗服务绩效评价存在的问题。收支结余法和基于资源相对价值量表分别尝试从经济和工作量的视角测量医疗卫生服务绩效,却相应扭曲了医疗卫生服务价值和错配了激励机制。当前医疗卫生服务绩效评价的发展困境在于医疗卫生服务的非同质性,可采取新“工分制”、按绩效支付和价值医疗等破解对策。未来医疗卫生服务绩效评价应以人民健康为中心,注重患者体验和健康等指标。

The key to health reform lies in the performance evaluation of health care staff.Based upon the perspective of performance evaluation,this paper reviews the six stages of health reform since the founding of People s Republic of China,including the planned economy,discontinuity in the initial reform and opening up,exploration in the economic transition,health care marketization,self-communion and new health reform.The principles and incentive mechanisms of the balance of payments and the resource-based relative value scale(RBRVS)are intensively investigated,to inspect the issues existing in the performance evaluation of health care services.The balance of payments and RBRVS attempt to measure the performance of health care services in terms of economy and workload respectively,but they distort the value of health care services and mismatch incentive mechanisms respectively.The current development dilemmas of health care performance evaluation lie in its non-homogeneity,and then the countermeasures including a new work-point system,performance-based payment,value-based health care are suggested.The future performance evaluation of health care services should focus on people s health and pay attention to the indicators of patients experience and health.