多点执业背景下公立医院医师薪酬分配制度研究

医师多点执业渐行渐近,探索多点执业背景下医师薪酬制度设计,以适应新的管理体制。作者通过对国内外公立医院医师薪酬制度的比较分析,结合我国医师多点执业现状及薪酬分配存在的问题,探讨我国多点执业背景下公立医院医师薪酬分配制度,包括协商,谈判及第三方介入,为卫生主管部门制订相关指导政策及多点执业医院制订薪酬策略提供参考。     

公立医院医师薪酬制度国际经验及借鉴

随着公立医院改革不断深入,公立医院医师薪酬制度也逐渐成为当前改革的重要议题。文章运用文献回顾和比较研究的方法,分析了不同卫生体系下的美国、德国、法国、日本、英国公立医院的薪酬模式、薪酬水平、工作负荷,总结了五个国家薪酬制度的特点,提出了我国公立医院薪酬改革应适度提高薪酬水平、加大固定薪酬比例、加强非经济激励因素的作用,优化薪酬结构,完善薪酬制度等建议。     

基于平衡计分卡的医师薪酬分配设计

制定能够合理补偿和体现医师价值的薪酬分配体系关系到国家公立医院改革的成败。公立医院医师薪酬分配机制,既有别于非公立医院中医师薪酬的高度市场化激励政策,又有别于以往计划经济时代薪酬的高度集权化管理制度。笔者主要在医疗体制改革和事业单位绩效工资改革的背景下,分析公立医院医师薪酬分配中存在的问题,讨论变革背后公立医院医师薪酬分配机制的转变问题,介绍基于平衡计分卡的医师薪酬分配方案。     

上海市与其他地区公立医院医务人员薪酬状况的比较分析

目的 :总结上海与其他地区公立医院医务人员薪酬状况的差异,归纳上海市公立医院医务人员薪酬制度的成效与不足,为上海市医务人员薪酬改革提供参考。方法 :检索相关统计年鉴和国内外相关文件文献,在专家咨询的基础上,对上海市与其他国家(地区)及我国典型省市的公立医院医务人员薪酬水平和结构进行比较分析。结果 :与其他国家(地区)相比,上海市公立医院医务人员薪酬水平明显较低。与国内其他典型省市相比,上海市医师薪酬水平在参比省市中最高,护、技、药类医务人员薪酬水平在结构上低于我国其他地区。结论 :建议合理提升上海市医务人员薪酬水平,建立合理的收入分配和激励机制,利用薪酬杠杆促进医疗队伍的可持续性发展。同时,应加强对公立医院薪酬分配制度改革特殊特点的研究,探索适合市情国情的医务人员薪酬制度。     

国际视角下我国公立医院薪酬制度改革现状研究

采用文献回顾和比较研究的方法,从薪酬水平、薪酬结构、薪酬分配要素、薪酬支付方式、管理者薪酬等方面系统梳理和比较了国内外公立医院的薪酬制度,分析了我国公立医院薪酬制度改革典型试点的现状并总结其经验,为其他地区的改革和建立符合我国国情的公立医院薪酬制度提供借鉴和参考。     

公立医院薪酬制度改革难点及其对策研究

公立医院薪酬制度改革是我国医药卫生体制改革的重要内容,更是公立医院高质量发展亟待解决的重点和难点问题。通过文献研究和比较分析,梳理我国公立医院薪酬制度改革历程和医务人员薪酬现状,并比较部分发达国家公立医院薪酬体系间的差异;探讨了我国在该领域存在的政府财政投入不足且不均衡、薪酬制度保障薄弱、医务人员薪酬水平偏低、内部差距不合理、绩效考核分配不科学等问题。从加强政府财政投入、落实制度保障、完善绩效考核分配体系、非经济性薪酬补偿、加强信息化支撑5个方面提出对策和建议,为进一步提高改革成效提供参考。     

美国医师薪酬支付方式改革的几种模式探析

通过对美国在联邦医疗保险体系中实行的不同薪酬支付方式(按绩效支付、按治疗事件支付、责任性医疗组织、以患者为中心的医疗之家)及美国薪酬体系改革几种模式的介绍,了解各种支付方法改革的目的、形式和具体实施中存在的问题,以期对我国的公立医院薪酬制度改革提供参考。     

江西省公立医院医师多点执业认知调查分析

目的探究江西省公立医院医师多点执业的意愿分析。方法采用自编问卷对江西省5家三级甲等公立医院的医务人员进行问卷调查,对调查结果进行分析。结果大部分医师对多点执业持赞同态度,但实施过程受医师身份、风险责任分担、薪酬待遇及执业时间地点等问题限制。结论针对医师对多点执业影响因素的看法,提出改革现行人事制度、明确医师医疗风险法律责任、保障医师薪酬待遇等建议。     

关于我国公立医院人力资源制度改革的设想

当前我国公立医院的人力资源制度已经明显不能适应现代医院改革和发展的要求,存在着管理体制僵化、人才流动机制不完善、薪酬机构设计不合理、晋升制度缺乏科学性、绩效评估缺乏有效性等问题。文中对今后我国公立医院人力资源管理制度改革提出建立平等开放的用人制度,设计责权明确的工作岗位职责,建立公平合理的薪酬分配制度,健全绩效考评机制,管理事务人员专业化等设想。     

公立医院薪酬制度改革与薪酬分配体系研究

通过系统梳理公立医院薪酬制度改革现状,分析薪酬制度改革与薪酬分配体系建设的核心要素,并基于薪酬分配与经济运行的关系、薪酬结构、分配机制、绩效考核、公平性五方面核心要素,探讨公立医院薪酬制度改革可能存在的阻力和难点问题,从加大公立医院补偿、加强文化建设、提高经济管理能力、加强绩效考核等方面提出相关建议,为公立医院薪酬制度改革以及公立医院薪酬体系建设提供参考.     

Hospital payment systems: will payers like the future better than the past?

Unsustainable health care cost growth has forced payers to reexamine goals for hospital payment systems. Employers want simplicity and transparency, with comparative performance data available in the public domain. Insurers favor simplicity but prefer to keep the analysis of comparative performance data and pricing private. Thirty-five pay-for-performance experiments have been devised in the private sector, to reward hospitals for higher quality and move toward more effective payment systems. Definitive results are not yet known, and caveats remain, but early signs are promising. We develop three scenarios for future hospital payment systems and identify policy actions to improve outcomes.     

医保付费方式与医院体制机制适配原则和形式——县级公立医院补偿机制改革研究(七)

在医疗保险付费方式改革和公立医院综合改革相继出台的情况下,有必要探讨医疗保险付费方式改革和公立医院综合改革的统筹推进问题。探讨保险付费方式和公立医院体制机制搭配的主要原则、错配形式和适配形式,以及适配形式选择的主要依据,依此向政府提出统筹推进医疗保险付费方式改革和公立医院综合改革的政策建议。     

Public hospital payment system in Spain: the experience of Catalonia and Andalusia

Since the mid-1990s, the introduction of new public hospital payment systems to improve the efficiency of Spanish hospitals within the context of managed competition has been debated. Blended systems, which recognize the importance of the activity performed, as well as the role of the hospital in the public health system, have emerged as the best-matched tools both in risk assignment and in efficiency-economic feasibility dialectic.In this article, the payment method used in Catalonia since 1997 is analyzed and contrasted with that introduced in Andalusia in 1998. The evaluation focuses on the instruments used to incorporate the mixed model in the two different settings. On the one hand, the capacity of diagnosis related groups (DRGs) to define hospital product cost is limited. Furthermore, DRGs require numerous adjustments before introduction into Spain. On the other hand, structural level can be defined through the Grade of Memberships in Catalonia and the Basic Centers in Andalusia.We also analyze the introduction of the different methods into Spain and their adaptation to the Catalan and Andalusian environments. The transition periods seem not to have led to a definitive solution and have served to highlight the fragility of the instruments used and of the use that has been made of them.We conclude that the introduction of new tools to improve hospital efficiency through payment systems was precipitate and, to a certain extent, naive. Public hospital payment systems can be considered to be effective when they manage to allocate resources over a period of time. Ensuring the efficiency of public hospitals implies daily work on the part of each hospital and the information systems generated by regional health systems and will not be achieved through external financial tools poorly adapted to the setting in which they are applied.     

医院开展单病种付费的基本条件

通过案例研究讨论了医院由"按项目收费"的支付方式过渡到"单病种付费"的支付方式,所需要具备的基础条件,具备了这些基础条件的医院可以进行单病种限价试点,而要想确保医院单病种限价的可持续发展,还需要一些其他条件。     

天津市公立医院补偿情况分析及对策研究

建立合理的补偿机制对公立医院的可持续发展至关重要,可以实现医疗资源的有效分配和利用。本文对天津2006至2008三年的公立医院补偿情况进行分析,同时在分析了当前公立医院补偿机制存在问题的基础上,提出相应对策。     

The influence of bonus payments to doctors on hospital revenue: results of a quasi-experimental study

There is wide consensus that the ways in which providers are reimbursed by third parties will affect their behaviour and, hence, the efficient use of limited resources and the performance of health systems. However, there seems to be little evidence on how payment to hospital-based doctors affects hospital performance. This paper reports a case study conducted in China on the effects of different types of bonus payment to doctors, with a focus on how bonus payment might have affected hospital revenue growth. This has been an increasingly important goal of public hospitals as they have gained increased autonomy. A set of longitudinal quasi-experimental data, and a set of cross-sectional data, both derived from 108 public hospitals, were used for the analysis. It was found that, when a bonus system was introduced, and when the bonus model switched from one with a weaker incentive to provide services to one with a stronger incentive, there was a consistent sudden increase in the rate of growth of hospital revenue. Bonus type was also associated with the size of hospital service revenue. The results highlight the potential risks of linking remuneration too closely with revenue generation, and the need to ensure adequate attention to mechanisms of control and accountability when hospitals are given greater autonomy.     

某大型三级公立医院在DRGs付费形势下医院管理探索

DRGs付费是当前国际上公认的比较先进和科学的付费方式,其强化了医保对医疗行为的引导、制约和监管作用,对医院管理提出了更高要求.自2018年沈阳市医保实施DRGs付费以来,某大型三级公立医院各相关部门协同配合,结合医院自身特点,积极探索管理办法,采取多种措施,逐步适应了医保支付方式改革,在控制医疗费用增长、提高医疗质量...     

Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries

Objective

This paper provides a comprehensive overview of hospital payment systems based on diagnosis-related groups (DRGs) in low- and middle-income countries. It also explores design and implementation issues and the related challenges countries face.

Methods

A literature research for papers on DRG-based payment systems in low- and middle-income countries was conducted in English, French and Spanish through Pubmed, the Pan American Health Organization’s Regional Library of Medicine and Google.

Findings

Twelve low- and middle-income countries have DRG-based payment systems and another 17 are in the piloting or exploratory stage. Countries have chosen from a wide range of imported and self-developed DRG models and most have adapted such models to their specific contexts. All countries have set expenditure ceilings. In general, systems were piloted before being implemented. The need to meet certain requirements in terms of coding standardization, data availability and information technology made implementation difficult. Private sector providers have not been fully integrated, but most countries have managed to delink hospital financing from public finance budgeting.

Conclusion

Although more evidence on the impact of DRG-based payment systems is needed, our findings suggest that (i) the greater portion of health-care financing should be public rather than private; (ii) it is advisable to pilot systems first and to establish expenditure ceilings; (iii) countries that import an existing variant of a DRG-based system should be mindful of the need for adaptation; and (iv) countries should promote the cooperation of providers for appropriate data generation and claims management.     

Costs per discharge and hospital ownership under prospective payment and cost-based reimbursement systems in Taiwan

This study in Taiwan examined the relationships between health care costs and hospital ownership under two financing systems with diametrically opposite incentives, case-payment (a form of prospective payment) and cost-based reimbursement. The universal sample of patients treated in 2000, for three standard care groups under each payment method, was included. The case payment diagnoses were uncomplicated cases of caesarean section, femoral/inguinal hernia operation and thyroidectomy, and the cost-based reimbursement diagnoses were uncomplicated cases of benign breast neoplasm, pneumococcal pneumonia and traumatic finger amputation. Costs per discharge were significantly lower in for-profit hospitals (by 2.8 to 5.7%) compared with public and not-for-profit hospitals for case payment diagnoses, which is consistent with the literature on US hospitals. For the cost-based reimbursement diagnoses, for-profits had 11.5 to 21.8% higher costs per discharge. The opposite direction of associations under the two payment systems validates the assumptions of the property rights theory in Taiwan's health care sector. Three plausible explanations for the study findings are suggested: (1). greater productive efficiency in private hospitals under case payment, (2). cost shifting from case payment diagnoses to cost-reimbursed diagnoses, and (3). patient dumping. Longitudinal studies using detailed hospital-level information with patient tracking facility are needed to clarify these issues.     

我国台湾地区RBRVS实践路径及其政策启示

在回顾归纳台湾地区RBRVS的发展历程及不同阶段的技术体系基础上,提出对大陆地区医保支付制度改革的政策启示:建立定调价多元主体参与机制,强化专科医学会对支付制度的支撑功能;建立医务人员人力技术价值评价体系和支付标准点值体系;完善公立医院区域成本数据库建设,健全专科间串联机制;探索基于点值体系的收付费一体化机制;建立健全公立医院薪酬制度与支付制度联动机制等政策建议。