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付费方式是医疗保障制度的核心环节。当前,将应用于不同服务、不同提供者的付费方式打包描述和研究的方式导致了研究结论的混乱。本文以适用于医疗机构的付费方式为研究对象,以31个国家为研究样本进行归纳研究。本文首先依改革开始时医疗保障制度的不同将样本国家分为三组,归纳不同医保制度下付费方式演进的一般规律。随后,描述和归纳样本国家应用于医疗机构的付费方式及其组合现状和设置规律。最后,考虑我国应用于医疗机构付费方式现状,提出对我国的建议。研究发现绝大多数样本国家采取付费方式组合;样本国家虽存在五种不同付费方式组合,但总体呈现出走向以疾病诊断相关分组为基础村费方式组合的趋势;社会医疗保险和国家卫生服务付费方式发展路径存在差异,但引入医疗服务购买机制后逐步趋同;提供者和购买者是否分开和医疗机构自主权都决定了付费方式的具体使用。本文建议我国基本医疗保险付费方式需进一步走向精细化和组合化。一是依医疗服务特点分别确定付费方式并逐步精细化;二是依据卫生政策需要灵活使用各种付费方式;三是逐步从单一付费方式走向付费方式组合;四是付费方式组合逐步转为按病种付费为主。
Payment method is the core part of the medical insurance system. At present, the ways in which the payment methods of different providers, which are applied to different services and are packaged and described by different providers, lead to confusion in the conclusions of the study. In this paper, the payment method for medical institutions as the research object, with 31 countries as the research sample induction. This article first divides the sample countries into three groups according to the different medical insurance system at the beginning of the reform, and summarizes the general rules of evolution of payment methods under different health insurance systems. Subsequently, describe and summarize the payment methods applied to medical institutions in the sample countries and their combined status quo and setting rules. Finally, considering the status quo of payment methods used in medical institutions in our country, we put forward suggestions to our country. The study found that the vast majority of sample countries adopted a combination of payment methods. Although there were five different combinations of payment methods in the sample countries, the overall trends of combination of village fees based on the grouping of disease diagnosis tended to converge. Social health insurance and national health service payment There are some differences in the mode of development pathways, but the gradual convergence of medical service purchase mechanism has been introduced. Whether the providers and purchasers are separated and the autonomy of medical institutions all determine the specific use of the payment method. This paper suggests that China’s basic medical insurance payment methods need to further refinement and combination. First, according to the characteristics of medical services, respectively, to determine the payment method and gradually refined; Second, based on the health policy needs flexible use of various payment methods; Third, gradually from a single payment to pay for portfolio; Fourth, Pay-based.