美国价值医疗支付改革中替代支付模式试点经验及其启示

The pilot experience and enlightenment of alternative payment models in the value-based medical payment reform in the United States

美国替代支付模式类试点项目起源于2010年《平价医疗法案》的实施,希望通过建立新的支付模式来替代传统的按服务收费支付,从而实现保障医疗质量、降低医疗成本和改善医疗公平性的目的。替代支付模式试点项目包括责任医疗组织和捆绑医疗支付计划两种,作者分别介绍了其基本情况和实施效果,分析了当前实施效果的成因,并提出对我国价值医疗支付改革的启示,以期为我国基于价值的优质医疗服务体系建设提供借鉴。

The pilot project for alternative payment models was originated from the implementation of the 2010 Affordable Care Act in the United States,which aimed to establish a new payment mode to replace the traditional payment based on service fees,thereby achieving the goals of ensuring healthcare quality,reducing healthcare costs,and improving healthcare equity.The pilot projects of alternative payment models included two types:accountable care organizations and bundled payments for care improvement.The authors introduced their profile and implementation effects,analyzed the causes of the current implementation effects,and then proposed enlightenments for the value-based medical payment reform in China,with the aim of providing reference for the construction of a high-quality value based medical service system in China.