完善卫生转移支付制度分析

通过分析江西省卫生专项的投入规模、投入结构和投入效果，发现目前中央卫生转移支付重点目标不明确，卫生专项中混合有财力补助性质和外溢性补偿性质两种转移支付目的，并且可能导致政府间卫生职责不清等问题。建议必须明确卫生转移支付的重点目标、规范卫生专项转移支付、归并和整合性质类似的专项以及建立专项绩效评价机制等。     

Medicare payment system for ambulatory surgical centers

Ambulatory Surgical Centers are paid under a fee schedule for eight service cost categories. The fee schedule is geographically wage adjusted and is updated annually. Anticipated future adjustments to the Ambulatory Surgical Centers prospective payment system (PPS) includes conversion to resource based rates.     

Institutional responses to Medicare's prospective payment system

The introduction of Medicare's prospective payment system (PPS) meant an important change in the environment of US hospitals. The new payment system was expected to improve clinical and non-clinical efficiency in hospitals. A case study in a non-profit Pennsylvania hospital was performed to analyse the impact of PPS on hospital services. The hospital responded to PPS by a twofold strategy. First, attempts were made to achieve effective cost containment by improving the efficiency of intermediate and final outputs. Here special attention is paid to the activities of the DRG coordinator and the Utilization Review Committee and to the activities of nurses in their role as case manager. The second strategy was directed at revenue enhancement, initially mainly by shifting more costs to non-Medicare patients and later by trying to strengthen the position of the hospital in the local health care market. This second strategy was considered more important than the strategy of cost containment. With respect to organizational structure and policy-making, the following changes can be observed: a growing importance of strategic management; more integrated hospital-physician relationships; and the development of an adequate medical information system and a medical records department.