Towards incentivising integration: A typology of payments for integrated care

Traditional provider payment mechanisms may not create appropriate incentives for integrating care. Alternative payment mechanisms, such as bundled payments, have been introduced without uniform definitions, and existing payment typologies are not suitable for describing them. We use a systematic review combined with example integrated care programmes identified from practice in the Horizon2020 SELFIE project to inform a new typology of payment mechanisms for integrated care. The typology describes payments in terms of the scope of payment (Target population, Time, Sectors), the participation of providers (Provider coverage, Financial pooling/sharing), and the single provider/patient involvement (Income, Multiple disease/needs focus, and Quality measurement). There is a gap between rhetoric on the need for new payment mechanisms and those implemented in practice. Current payments for integrated care are mostly sector- and disease-specific, with questionable impact on those with the most need for integrated care. The typology provides a basis to improve financial incentives supporting more effective and efficient integrated care systems.     

肝癌基本检查和治疗项目支付范围研究

随着医疗保险改革的不断深入,国务院发布了“关于建立城镇职工基本医疗保险制度的决定”,我们根据北京市６家医院的调查结果,探讨了肝癌的基本检查、治疗项目的支付范围、个人负相比例等问题,为全面推进医疗保险或医疗保障支付的可操作性,对制定医疗保险方案中按病种付费提供了参考。     

Health Policy and Clinical Practice in the New Era of Quality

April 27th, 2016 executive notice by the US Department of Health and Human Services issued key provisions to the Medicare Access and Summary CHIP Reauthorization Act of 2015, (MACRA). MACRA replaced the 1997 Sustainable Growth Rate formula for determining Medicare reimbursement. MACRA provides a new approach in Medicare reimbursement based on value and quality care. MACRA legislation is guided by the Quality Payment Program, directing two paths for Medicare reimbursement: The Merit-based Incentive Payment System (MIPS), or the Advanced Alternative Payment Model (APM). Nurse Practitioners, require knowledge and information to prepare for MIPS and APM to begin January 1, 2017.     

新型农村合作医疗混合支付方式的博弈模型研究

利用博弈论基本概念和不完全信息动态模型,构建新农合经办机构与医疗机构之间关于费用控制的博弈模型,并利用博弈树,分析得到模型的均衡解,即经办机构选择预付制与后付制相结合的混合支付方式,才能使医疗机构有动力控制医药费用,并为新农合制度带来利益均衡,维持其可持续发展。但混合支付方式的具体表现形式需要通过委托一代理模型进行进一步论证。     

按病种付费相关伦理问题探讨

按病种付费的实施,规范了医疗行为,有效规避了医方道德风险,控制了医疗费用的增长,一定程度上避免医疗资源的过度浪费;统一的价格标准促进不同医院之间费用的平衡,保证了医疗服务的公平性.但同时也产生了限价与患者需求存在矛盾,医院的利己行为,新技术、新疗法应用的困境等医学伦理问题.通过对这些问题的分析,认为加强伦理教育,构建患者至上、医者仁心的医院文化;科学制定按病种付费各项标准,保证按病种付费顺利、有效实施;制定按病种付费管理考核办法,规范按病种付费诊疗行为;做好对医院的监管工作,积极维护参保人员利益等量解决此类问题的有效途径.     

我国居民个人卫生支出及其比重变化趋势研究

目的：了解我国居民个人卫生支出及其比重现状与变化趋势。方法：本文以2012年中国卫生统计年鉴和第四次国家卫生服务调查数据为基础,对收集的资料进行描述与统计分析。结果：我国居民个人卫生支出仍呈上升趋势,但比重有明显下降;城市居民卫生费用增长速度快于农村;居民个人卫生支出比重均不同。结论：继续增加我国政府卫生投入及其比例,完善医疗保险制度,提高卫生服务公平性。