市场结构约束下医疗服务价格形成机制与政策优化思路研究

Research on the price formation mechanism and policy optimization of medical services under the constraints of market structure

在分析中国医疗服务市场结构特征基础上,对当前医疗服务价格的形成机理与逻辑框架进行系统性剖析。医疗服务价格本质上是在市场信息不对称和技术服务差异化约束下,基于多层次市场结构,由政府、医疗服务机构、消费者和医疗支付机构等多方谈判与反复博弈的动态结果。医疗服务价格机制中存在主要的问题表现为:医疗服务项目比价不平衡,技术服务价格扭曲;定价调整机制没有顺应适配需求结构与层次变化;政府投入相对不足导致医疗服务价格形成不充分。针对存在的问题,提出了完善医疗服务成本核算和定价方法,合理引导就医需求;加强对药品、耗材的采购和使用管理,优化医院成本结构;强化与医保政策联动,发挥医保定价、控费、监管作用;建立弹性定价机制,实现医疗服务价格动态调整;加大配套支持力度,保障改革顺利进行等对策策建议。

Based on the analysis of the structural characteristics of China’s medical service market,this paper systematically analyzes the formation mechanism and logical framework of the current medical service price.The price of medical service is essentially the dynamic result of negotiation and repeated game among governments,medical service institutions,consumers and medical payment institutions based on multi-level market structure under the constraints of market information asymmetry and technical service differentiation.The main problems in the medical service price mechanism are as follows:the price comparison of medical service items is unbalanced,and the price of technical services is distorted;the pricing adjustment mechanism does not adapt to the changes of demand structure and level;the relative insufficiency of government investment leads to the inadequacy of medical service prices.In view of the existing problems,this paper proposes the folowing countermeasures:improving the cost accounting and pricing methods of medical service to reasonably guide the demand for medical care;strengthening the purchase and use management of drugs and consumables to optimize the hospital cost structure;strengthening the linkage with medical insurance policies to play the role of medical insurance pricing,fee control and supervision;establishing the flexible pricing mechanism to realize dynamic adjustment of medical service price;increasing supporting efforts to ensure the smooth implementation of reform.