公立医院补偿机制改革的国际经验与启示

摘要

介绍了国际上公立医院补偿机制的两种主要模式，即在实行国民卫生体制的国家及地区通常采用的以政府财政补偿为主的模式及在实行社会医疗保险体制和商业医疗保险体制的国家及地区采取的政府财政和医疗保险筹资的双重补偿模式。论述了在医疗费用快速上涨以及公立医院治理机制改革影响下，补偿模式改革的主要特点，即补偿渠道多元化；根据不同的补偿渠道，采取混合支付方式，财政补偿模式的国家及地区往往采用总额预算制，双重补偿模式国家及地区则一般以诊断相关分组预付制为主；实行医药分开，严格控制药品价格。提出对推进我国公立医院补偿机制改革的启示，即公共财政应是公立医院补偿的主要来源，以保持公立医院公益性；由于公立医院的固定成本的正外部性和控制医疗费用，该部分成本应主要通过政府财政补偿；通过采用预付制为主的混合支付方式进行补偿，建立影响公立医院医务人员行为的激励约束机制。%There are two main international modes of the compensation mechanism of public hospitals. One pattern is always used in the nations and districts of National Health System and compensated mainly by government financial. The other is usually used in the nations and districts of social and commercial medical insurance systems and compensated mainly by both government financial and medical insurance. Under the influence of medical expense rising and the reform of public hospital governance mechanism, the prevailing reform features of the two patterns are to develop diversified financing channel, separate drug and medical service, and take mixed payment based on prospective payment that is the nations and districts of government financial mode always take global budget, and those of both government financial and medical insurance usually take diagnosis related groups prospective payment system (DRGs-PPS). The revelations of international experience are: Public finances should be the main financing channel of public hospitals to ensure the commonweal. The fixed cost of public hospitals should be compensated by government financial because of positive externality and cost control. Mixed payment based on prospective payment should be taken to influence the behavior of public hospitals.