支付制度改革在当前卫生系统改革中具有重要的杠杆作用。卫生改革是多目标的,其结果受到多种因素的共同影响。仅靠支付方式转变很难实现多目标改革的预期结果。应因势利导、多管齐下,将一些基础条件逐步调整到某种支付方式适宜的条件下,支付方式才能通过激励机制发挥影响供方行为的作用。质量是卫生系统的核心目标之一,在第四代支付方式按绩效付费之前的其他支付方式对于质量改善并没有正向的直接激励作用,因此,在进行支付制度改革时必须考虑质量因素,根据不同支付方式的激励机制,辅以相应质量控制、监测与评估等多种配套措施,合理引导供方行为。 Payment system reform has an important leverage in the current health system reform. Health reform is multi-purpose and the result is influenced by many factors. It is difficult to achieve the expected results of the multi-objective reform simply by changing the payment method. Should be circumscribed by the situation, under a multi-pronged approach, some basic conditions will be gradually adjusted to a certain mode of payment appropriate conditions, payment methods to play through the incentive mechanism to play a role in supplier behavior. Quality is one of the core goals of the health system. There is no positive direct incentive for quality improvement when the fourth generation payment method is performance-based. Therefore, the quality factor must be considered in the reform of the payment system. According to Incentives for different payment methods, supplemented by corresponding quality control, monitoring and evaluation and other supporting measures, to guide the supplier behavior.