日本医疗费用合理化计划的政策变迁及经验启示

Policy Changes and Experience of Japanese Medical Expense Rationalization Plan

为全面有效缓解医疗费用不合理增长问题,自2008年起,日本已累计颁布实施三期医疗费用合理化计划。日本医疗费用合理化政策历经准备、探索、成形三个阶段,其指标的构建与变更、实施的方向与内容均以国民健康促进和医疗服务效率提升两方面为重点。经过基于当前与预期数据的政策评估,接续推进的多期计划无论是在作为结果的医疗费用指标上,还是在作为过程的细分领域指标上均取得了显著成效,在问题溯源、组合施策、部门联动、服务延伸、对象覆盖方面积累了有益经验,但也存在费用增长归因不够精准、指标设置缺乏指引、地方落实适应性和创新性不足、政策失灵风险较大等突出问题。日本的实践为我国在目标体系、沟通机制、协同体制、评估机制方面创新推进医疗费用合理化提供了重要的政策启示。

In order to comprehensively and effectively alleviate the problem of unreasonable growth of medical expense,since 2008,Japan has promulgated and implemented three-period rationalization plan of medical expenses.The rationalization of medical expense in Japan has gone through the stages of preparation,exploration,and formation,and the construction and change of its indicators,the direction and content of its implementation are focused on the promotion of national health and improvement medical service efficiency.After policy evaluation based on current and expected data,the successive multi-period plans have achieved remarkable results both in terms of medical cost indicators as an outcome and sub-field indicators as a process,and have accumulated beneficial experience in terms of problem tracing,combined policy implementation,departmental linkage,service extension,and target coverage,but there are also problems such as inaccurate attribution of expense growth,lack of guidance for indicator setting,inadequate adaptability and innovation of local implementation,and high risk of policy failure.Japanese practice provides important policy inspiration for China to innovate and promote the rationalization of medical expenses in terms of target system,communication mechanism,coordination system,and evaluation mechanism.