韩国医疗服务支付方式改革对我国的启示

Medical Provider Payment Reform in Korea and Its Revelation for China

随着我国城镇职工基本医疗保险制度改革的深入,支付方式的改革越来越显得重要,我国与韩国一样,在社会医疗保险初期,支付方式都是按服务项目付费。这种支付方式导致服务数量的增加、治疗方案的扭曲,医生更愿意提供收益好的服务。为了寻求解决办法,韩国在1997年尝试实施按诊断相关分组(DRG)的支付方式。通过对韩国支付方式改革的回顾,为我国城镇职工基本医疗保险支付方式的改革提供借鉴。

With the implementation of China urban employee' s basie health insurance, the provider payment is becoming more and mroe important. At the beginning of the social health insurance reform,Chinese provider payment as Korean's is regulated Fee-For-Service payment. It has resulted in an increased volume and intensity of medical care. It has also distorted the input mix of treatment because physicians have substituted more profitable. For solving this problem, Korea has implemented DRG payment instead of Fee-For-Service in some pilot hospitals since 1997. This paper reviews Korea provider payment reform in order to offer some references for the reform of the provider payment of China urban employee' s basic health insurance.