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、监洲与评估等多种配套措施,合理引导供方行为.%Payment system reform has an important role in the current health system reform. As health reforms have multiple objectives and are influenced remarkably by complex factors, only payment method transformation can hardly achieve the desired results of the health reforms with multiple objectives. Specific payment method or certain payment method mix could play a robust role in changing behaviors of providers by gradual adjustment to proper conditions. Quality is one of the core goals of the health system, however, before the fourth generation, namely pay for performance, none of the other payment methods have positive incentive on quality improvement. Specific payment method should be selected to be implemented in different regions with certain context. And based on the specific payment method with certain incentives, supporting polices, especially quality assurance policies and M&E measures should be issued.
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