美国按价值支付实践及对我国的启示

Practice of Value-based Payment in US.and Its Enlightenment to China

医保支付方式的改革是深化医改的重要组成部分,其对医疗服务提供者的行为具有重要的导向作用。美国医保支付改革的最新进展为推行“按价值付费”。文章采用文献研究法,对美国实施按价值付费的发展历程进行梳理,发现美国的支付方式改革主要针对医院和医师这两类对象展开,具有奖惩结合、横向和纵向评价相结合、持续改进评价体系、充分发挥信息化手段等特点。结合我国国情,提出今后医保支付方式改革应建立有效的激励机制、制定科学的评价体系、坚持持续优化的机制和加强医疗数字化建设等建议。

The reform of medical insurance payment is a critical part of deepening the medical reform.It plays an important role in guiding the behavior of healthcare providers.The latest progress in the reform of health insurance payment in the US.is the imple-mentation of value-based payment models.The literature research method is applied to review the development of value-based pay-ment practices in the US.It finds the main value-based payment models in the United States are targeted hospitals and physicians as the incentive object,with the characteristics of the combination of reward and punishment,the combination of horizontal and ver-tical evaluation,the continuous improvement of evaluation system,and the full use of information means.On this basis,combined with the national conditions of China,it puts forward four suggestions on establishing effective incentive mechanism,formulating scientific evaluation system,insisting on continuous improvement mechanism and strengthening medical information construction for future reform of medical insurance.