单病种限价收费的利弊分析

看病贵，是近年来人民群众反映强烈的问题之一。目前，我国医疗机构在收费上采用的是按项目收费办法，这种收费办法所带来的高管理成本和费用的不可控性一直为业内诟病。在我国基本医疗保险覆盖面很低、商业医疗保险还不发达的今天，按病种付费是一种能够有效控制费用且能相对较好地保证参保人员权益的支付方式。     

积极探索按病种付费方式的改革

长期以来，我国医疗机构一直采取按医疗服务项目付费的方式。这种提供什么项目服务就收取该项费用的单项收费办法比较直观，在计划经济时期发挥了一定作用。然而，在市场经济条件下，这种付费方式与控制医药费用增长不相适应，与规范医院和医生的医疗行为不相协调。尤其是按项目付费是形成“看病贵”社会热点问题的直接原因。为实现广大人民群众“看得上病、看得起病、看得好病”的新时期卫生工作服务宗旨，必须对付费方式实行改革，由原来的按项目付费，逐渐过渡到按病种付费。     

半个世纪的降价和限价政策,导致了医院的畸形收费

物价部门长期坚持的降价和限价政策,背离了医疗服务成本,与宏观改革环境和财政职能调整不配套,造就了畸形的医疗服务收费标准,改革中经济尤其是GDP增长优先的现实,客观上忽视了对医疗服务行业发展导向的把握,致使多设高新服务项目、多做检查、多开药等,成为医疗机构应对财政资金自筹政策采用的不二法宝,拉动了医疗费用的畸形增长,导致看病贵等问题成为现实。改革医院的支付方式,变目前物价部门控制的按项目收费为“总额预算＋按服务单元（人头费、病种）”,是短期内解决看病贵等问题,达成医疗、医药、医保三项改革目标的必由之路。     

推行按病种收费应注意的几个问题

有关部门试图通过推行按病种收费这一收费方式改革,来解决看病贵这一顽症。通过对这一收费方式的分析,总结出按病种收费不仅不能解决看病贵,而且还会引发一些新的矛盾和问题,建议有关部门推行应慎重。     

多元化医保支付方式对医院管理能力的影响

随着国家医疗卫生的改革的不断深入,社会医疗保障体系逐步完善,全民医保网络初步形成,也实现了医保支付方式多元化发展。医保制度改革的目的就是促进社会保障体系正常运行,以进一步控制医疗费用的增长幅度,解决人们"看病难""看病贵"的问题。医保支付制度的改革使按服务项目收费、按服务单元收费、按病种付费、按人头付费以及按预算总额付费等多元化医保支付方式与现行医保制度相适应,逐步增强医务人员的管理责任意识,合理调整医院各科室组成部分,进而有效提升公立医院的服务质量及整体管理水平,促使医院发展更规范、更理性。     

按病种收费应慎重推行

有关部门试图通过推行按病种收费这一收费方式改革,来解决看病贵这一顽症.本文通过对这一收费方式的分析,总结出按病种收费不仅不能解决看病贵,而且还会引发一些新的矛盾和问题,建议有关部门应慎重推行.     

解决看病贵等技术非常成熟,关键是政府的决心

医疗、医保、医药改革涉及的利益团体虽多，但是短期目标却非常简单，解决看病贵等问题、取得医改的突破，在技术上非常成熟，关键是政府是否有决心和理性。要达成三项改革的目标，其措施非常简单，只要改革目前医院的按项目收费方式，形成“总额预算＋按服务单元（或病种、人头）”支付方式，使得医院只有减少不必要的服务和药品利用才能够获得最大的收益，就能根除看病责问题，给医保以收支平衡的外部环境，患者就能吃上“价廉质优”药品、彻底消除“以药养医”。     

基于临床路径的单病种收费的收益风险与防范

以临床路径为基础的单病种收费作为一种新的支付方式,能够很好地控制医疗费用的不合理增长,但是由于“限价包干”及疾病风险的不确定,相比传统的按项目收费,医院实行单病种收费面临更多的收益风险。因此,有效防范单病种收费的收益风险已成为医院管理者面临的新问题。     

卫生政策研究征文优秀论文目录

·大会交流·“看病贵”的成因及其对策王良明等改进医疗费用支付方式,破解看病贵难题孙卫多一点社会宣传,多一份民众理解姜国和如何根治“大处方”解伟边远地区少数民族居民看病难与看病贵的原因分析与机制探讨杨立嵘等关于“看病难、看病贵”的思考刘家望解读“看病贵”何煜华等政府主导,五位一体,解决群众看病难看病贵的破冰之举王燕完善医院信息系统,缓解“看病贵”“看病难”解伟农村卫生发展必须优先发展知识能力崔春混合支付方式是新型合作医疗支付方式的合理选择苏榕生等论新型农村合作医疗管理机构的法律规制龙际谈“新型农村卫生…     

我国收付费协同的医保支付方式改革现状及发展趋势*

医保支付方式改革是医药卫生体制改革的重要抓手，也是形成“运行新机制”的必要措施，而实现收付费一体化与协同则是深化医保支付方式改革的必然要求。这不仅有利于提高医保基金的使用效率，也有利于从制度上减轻患者的经济负担。文章主要以DRG收付费为例，分析我国收付费协同的医保支付方式改革现状。研究发现：我国在开展的医保支付方式改革中，大多数地区只做到医保付费端，而医院收费端仍是按项目收费，即采用的是“收费”与“付费”并行的双轨制管理办法。尽管我国有福建省三明市等少部分地区逐步开展了收付费协同的医保支付方式改革探索，但“收—付”两端的协同改革仍须强化，同时“政策组合拳”的跟进也至关重要。     

Protecting the poor under cost recovery: the role of means testing

In African health sectors, the importance of protecting the very poor has been underscored by increased reliance on user fees to help finance services. This paper presents a conceptual framework for understanding the role means testing can play in promoting equity under health care cost recovery. Means testing is placed in the broader context of targeting and contrasted with other mechanisms. Criteria for evaluating outcomes are established and used to analyze previous means testing experience in Africa. A survey of experience finds a general pattern of informal, low-accuracy, low-cost means testing in Africa. Detailed household data from a recent cost recovery experiment in Niger, West Africa, provides an unusual opportunity to observe outcomes of a characteristically informal means testing system. Findings from Niger suggest that achieving both the revenue raising and equity potential of cost recovery in sub-Saharan Africa will require finding ways to improve informal means testing processes.     

Socialism and the British National Health Service

This paper examines some of the key characteristics of a socialist health care system using the example of the British National Health Service (NHS). It has been claimed that the NHS has socialist principles, and represents an island of socialism in a capitalist sea. However, using historical analysis, this paper argues that while the NHS claims some socialist ends, they could never be fully achieved because of the lack of socialist means. The socialist mechanisms which were associated with earlier plans for a national health service such as a salaried service, health centres, elected health authorities and divorcing private practice from the public service were discarded in negotiation. Moreover, even these would have achieved socialism merely in the sense of distributing health care, without any deeper transformation associated with doctor-patient relationships and prevention. In short, the NHS is more correctly seen as nationalised rather than socialised medicine, achieving the first three levels of a socialist health service identified here. It can be said to have socialist principles in the limited distributional sense and has some socialist means to achieve these. However, it lacks the stronger means to fully achieve its distributional goals, and is very distant from the third level of a radical transformation of health care.     

Bridging the gap between information and health. The role of an information broker.

In Croydon, health information is not only accessible to health educators. A pioneering approach means that links have been forged with community agencies, and with local public libraries, which serve as useful vehicles for health promotion. In the second part of our series, Sue Lacey Bryant describes how the system was established, how it works, and the positive reactions it has stimulated.     

开展医院健康教育的思考

对开展医院健康教育的意义、内容、实施方法及需要研究的问题进行了探讨。健康教育是医院的重要职能;健康教育是一种治疗手段;健康教育是整体护理的重要组成部分。开展医院健康教育应掌握行为科学、传播学和预防医学的知识。开展医院健康教育需要对住院病人健康教育需求,健康教育内容、形式、方法,护士在医院健康教育中的作用,健康教育效果的评估及健康教育的体制要进行研究     

Priority setting in public and private health care. A guide through the ideological jungle.

Priority setting means deciding who is to get what at whose expense. In the context of health care, the 'what' is that statement refers to different sorts of health care, and the 'who' to different sorts of people. The 'whose expense' is not so straightforward. It appears to refer to 'who will pay the bill', and in a public health care system this might seem to be the government, though behind the government stands the taxpayer, and that means all of us. Even in a private health care system it is rarely the patient who meets the bill directly, for some or all of it will be met by an insurer, and the costs of any particular treatment episode will be spread over many premium-payers. But in the context of an economic, rather than a financial, analysis the phrase 'at whose expense' has to be interpreted in a different way, based on the notion of opportunity cost, rather than on the notion of expenditure. When so reinterpreted, it means 'who is to go without' health care in order that other shall have it. Giving priority to one group of people means taking it away from another group, though for obvious reasons politicians tend not to dwell on this implication, leaving us to infer, from what is not said, who the 'low priority' groups are. In any honest and open discussion of these issues, however, that implication must be faced squarely, and we must not shrink from identifying who (implicitly) the 'low priority' people are, in any particular system of health care.     

天津市区域卫生规划的实施与政策环境分析

区域卫生规划的有效实施与当地的卫生政策环境密切相关。近年来，在天津市政府的领导下，卫生部门通过营造有效的政策支持环境与整体制度设计，不仅使区域卫生规划得到较好的实施，也促进了天津卫生改革与发展。在区域卫生规划指导下，天津在卫生资源调整、卫生服务体系建设、提高卫生服务的公平性方面进行了有益的实践。     

Global health priorities – priorities of the wealthy?

Health has gained importance on the global agenda. It has become recognized in forums where it was once not addressed. In this article three issues are considered: global health policy actors, global health priorities and the means of addressing the identified health priorities. I argue that the arenas for global health policy-making have shifted from the public spheres towards arenas that include the transnational for-profit sector. Global health policy has become increasingly fragmented and verticalized. Infectious diseases have gained ground as global health priorities, while non-communicable diseases and the broader issues of health systems development have been neglected. Approaches to tackling the health problems are increasingly influenced by trade and industrial interests with the emphasis on technological solutions.     

危险管理法在农村儿童保健中应用效果评价

在儿保领域应用危险管理法目的是充分利用有限的卫生资源,减轻基层儿保人员负担,提高儿保服务效果和儿童健康水平。通县农村于1990年以来婴幼儿保健中应用危险管理法的研究显示,高危儿健康状况在加强管理后与非高危儿的相近;实验组与对照组儿童在婴幼儿期的死亡及婴幼儿后期生长发育方面差别无统计学意义;儿童满5岁时,两组生长发育水平无显著性差别。提示在我国有限卫生资源基础上,应用危险管理法于儿保领域有重要现实意义。     

On the aggregation of health status measures

In the present paper, we address the problem of finding conditions under which aggregation of individual health status measurements (e.g. QALYs) is meaningful in the sense that there is a universal unit of measurement for health. The problem is studied in a model where different aspects of health take the form of Lancasterian characteristics to be produced by the individuals using commodities obtained in the market. For a meaningful unit of measurement to exist, marginal rates of substitution between different aspects of health should not differ among individuals, and for this to happen in an equilibrium of the economy considered, certain assumptions of separability (of technology and/or preferences) must be satisfied. This means that universal measures of health will be meaningful only if there are not too many spillovers in achieving different aspects of health.     

Pandemic obesity and the contagion of nutritional nonsense

The United States is the epicenter of an obesity pandemic. As more countries acculturate to a Western lifestyle, rates of obesity and its sequelae are rising steadily in both adults and children. In response, a variety of weight-loss diets emphasizing alternative distributions of macronutrient classes have been promoted with considerable success. Among the most popular is the so-called "Atkins Diet," in which carbohydrate restriction is touted as the key to weight loss. Despite claims, however, evidence that weight loss is enhanced by means other than caloric restriction is lacking. Also lacking is evidence that fad diets produce sustainable weight loss. Most important, fad diets generally ignore or refute what is known about fundamental associations between dietary pattern and human health. Cancer, cholera, and AIDS induce rapid weight loss, highlighting the potential incompatibility of weight loss by any means with health. Available data suggest that long-term weight loss is most consistently achieved by adherence to a fat-restricted diet abundant in grains, vegetables, and fruit, along with regular physical activity, a lifestyle notably conducive to the promotion of overall health. Fad diets, potential harms of which are well characterized, should be presumed "guilty" of incompatibility with human health until or unless proved otherwise; the burden of proof should reside with proponents. In the interim, the clinical and public health communities should work to empower individuals with knowledge needed to reconcile weight control with health promotion; support policies that mitigate obesogenic environmental conditions; and offer unified resistance to the contagion of dietary propaganda.