美国医保支付方式改革经验及对我国的启示

Experience of the reform of medical insurance payment in the United States and its enlightenment to China

文章梳理了美国医保支付方式从按项目付费到DRG、RBRVS再到按价值付费(VBP)演变的做法及经验,总结了我国正积极探索的以DRG和DIP为代表的按病种付费为主的多元复合式医保支付方式实践及挑战。结合美国经验和我国实践提出以下完善建议:①不断优化完善DRG和DIP为主体的预付制改革;②探索构建以价值为导向的支付方式改革评价机制;③建立绩效激励机制,推动支付方式改革落地;④构建医方、保方对话平台,建设具有中国特色的支付方式。

This paper reviews the evolution of healthcare payment methods in the United States from fee-for-service to diagnosis-related groups(DRG),resource-based relative value scale(RBRVS)and value-based payment(VBP),while summarizing the practice and challenges of the diversified and multi-compound medical insurance payment represented by DRG and DIP,which is actively explored in our country.The following suggestions are put forward based on American experience and Chinese practice.First,China should actively promote the reform of prepaid system by taking DRG and DIP as the core.Second,the evaluation mechanism for value-oriented payment reform should be established.Third,a performance-based incentive mechanism should be established to promote the reform of payment methods.Furthermore,it is suggested that a dialogue platform be established between healthcare providers and insurers to construct a payment method with Chinese characteristics.