DIP支付方式与紧密型医共体总额付费政策融合研究

在DIP的政策框架范围内,探索DIP支付方式与紧密型医共体总额付费政策融合模式,分析各模式对医共体服务行为影响。本研究应用博弈论从政府和医共体、医共体和医疗机构双层经济激励结构,即外部支付方式和内部分配模式两个层面,构建医共体打包付费三个组合模式下的博弈模型。研究发现,当DIP支付方式既用于外部支付,又用于内部分配时,扩大服务量为最优策略,容易导致医共体内外竞争;当只用于外部支付,不用于内部分配,仍持续对外进行服务扩张,内部分配制度的设计空间不足;当不用于外部支付,只用于内部分配时,有助于通过按人头总额付费削弱医共体对外的无序竞争,同时通过DIP支付规则,应用区域内不同点值规范医疗机构恶意扩大服务量的不合理行为。     

基于全周期管理的中美日仿制药替代促进政策对比研究

目的:基于全周期管理理念,从仿制药研发注册、市场准入、临床使用和上市后再评价多个环节为我国仿制药替代促进政策的制定和完善提供建议。方法:采用文献研究法和对比分析法,对我国和美日的仿制药替代促进政策现状进行对比分析。结论:仿制药替代是涉及多个环节的系统工程,美国和日本通过在研发注册环节不断完善技术标准和数据指南,在市场准入环节合理定价和医保激励,在临床使用环节管理医师药师处方行为、加强宣传教育,在上市后再评价环节对仿制药进行再评价和替代效果评估,构建了全周期的仿制药替代促进政策体系,实现了仿制药替代目标。     

Changes in inpatients' distribution and benefits under institution level–based quota payment for specific diseases in rural China: An interrupted time‐series analysis

The distribution of patients is increasingly disordered in China, which leads to the waste of medical resources, increase in inpatients' economic burden, and decrease in benefits from health insurance. Institution level–based quota payment for specific diseases represents a typical payment‐system reform mode in rural China that rationalizes the distribution of rural inpatients. The aim of this study is to evaluate the effectiveness of this mode by estimating rural inpatients' distribution among hospitals at different levels, per capita cost of hospitalization, and actual compensation ratio and then to provide suggestions to advance this mode. Interrupted time‐series analysis was applied to evaluate the effect of the reform mode in the study, and Weiyuan County, Gansu Province, was selected as our sample. Institution level–based quota payment for specific diseases in Weiyuan County has rationalized the distribution of rural inpatients and improved their benefit levels. Further research should be conducted to evaluate the appropriateness of medical services, the health outcomes of rural inpatients, and the sustainability and replicability of the policy.     

An unintended consequence of provider payment reform: The case of capitation grants in the National Health Insurance reform of Indonesia

One of the most important components of the ambitious 2014 National Health Insurance reform in Indonesia is the implementation of prospective payment system known as capitation grants, paid monthly to the primary health providers based on the enrolment rate. This has ushered in additional financial resources for the health managers in resource allocations, especially in the hiring of manpower. Drawing data from the Indonesia Family Life Survey (1993‐2015), this paper uses difference‐in‐differences method to evaluate the effects of the payment method reform on the allocation of human resources for health among the primary health providers. To our surprise, there was no statistically significant change in the total number of full‐time staff among the capitated facilities after the reform. However, capitation grants caused an increase in the number of full‐time equivalent and part‐time equivalent contract staff, but a significant decline in the number of full‐time permanent staff among the urban capitated facilities. It is likely that more contract health workers were hired at the expense of full‐time permanent staff among the capitated facilities in the urban regions. This unintended consequence shed light on the need to develop nuanced and contextual understanding of payment reforms in developing countries.     

Effects of Medicare payment changes on nursing home staffing and deficiencies

OBJECTIVE: To investigate the effects of Medicare's Prospective Payment System (PPS) for skilled nursing facilities (SNFs) and associated rate changes on quality of care as represented by staffing ratios and regulatory deficiencies. DATA SOURCES: Online Survey, Certification and Reporting (OSCAR) data from 1996-2000 were linked with Area Resource File (ARF) and Medicare Cost Report data to form a panel dataset. STUDY DESIGN: A difference-in-differences model was used to assess effects of the PPS and the BBRA (Balanced Budget Refinement Act) on staffing and deficiencies, a design that allows the separation of the effects of the policies from general trends. Ordinary least squares and negative binomial models were used. DATA COLLECTION METHODS: The OSCAR and Medicare Cost Report data are self-reported by nursing facilities; ARF data are publicly available. Data were linked by provider ID and county. PRINCIPAL FINDINGS: We find that professional staffing decreased and regulatory deficiencies increased with PPS, and that both effects were mitigated with the BBRA rate increases. The effects appear to increase with the percent of Medicare residents in the facility except, in some cases, at the highest percentage of Medicare. The findings on staffing are statistically significant. The effects on deficiencies, though exhibiting consistent signs and magnitudes with the staffing results, are largely insignificant. CONCLUSIONS: Medicare's PPS system and associated rate cuts for SNFs have had a negative effect on staffing and regulatory compliance. Further research is necessary to determine whether these changes are associated with worse outcomes. Findings from this investigation could help guide policy modifications that support the provision of quality nursing home care.     

山东省县级公立医院医保支付方式改革实施现状研究

目的分析县级公立医院医保支付方式改革实施现状,发现问题并提出对策。方法通过邮寄问卷与实地调研的方法收集数据,采用SPSS19.0对数据进行运算处理与分析。结果参与山东省第一、二批县级公立医院改革的医疗机构中160家(92.5%)进行了医保支付方式改革,但支付方式仍较单一;开展按病种限价付费与按病种定额付费的医院中,病种数量超过50种的分别占26.2%、11.4%;63.8%的医疗机构考核结果与医保支付挂钩等。结论应推行复合型付费方式,增加按病种付费的病种数量,克服医保支付方式改革推行过程中来自"医、保、患"三方的阻力,发挥支付方式对医疗机构的正向引导作用。     

新型卫生投入政策研究

本文提出了一整套新型卫生投入政策方案，总目标是建立起“四级两块式”卫生投入政策，具体目标模式有：改革卫生投入方式，实行“五级浮动式”医疗价格体制，建立医疗价格政策性补贴，增加公共卫生投入，整合卫生资源。并进行可行性论证。     

How should hospital reimbursement be refined to support concentration of complex care services?

The English National Health Service is promoting concentration of the treatment of patients with relatively rare and complex conditions into a limited number of specialist centres. If these patients are more costly to treat, the prospective payment system based on Healthcare Resource Groups (HRGs) may need refinement because these centres will be financially disadvantaged. To assess the funding implications of this concentration policy, we estimate the cost differentials associated with caring for patients that receive complex care and examine the extent to which complex care services are concentrated across hospitals and HRGs. We estimate random effects models using patient‐level activity and cost data for all patients admitted to English hospitals during the 2013/14 financial year and construct measures of the concentration of complex services. Payments for complex care services need to be adjusted if they have large cost differentials and if provision is concentrated within a few hospitals. Payments can be adjusted either by refining HRGs or making top‐up payments to HRG prices. HRG refinement is preferred to top‐payments the greater the concentration of services among HRGs.     

四种治疗难治性肺结核方案的费用-效果分析

目的探讨不同的药物治疗方案对难治性肺结核的费用-效果。方法运用费用-效果分析法对A、B、C、D4种治疗难治性肺结核的方案进行分析评价。结果每种方案结核菌阴转率的费用-效果比(元/%)分别为,A:30.94,B:24.42,C:25.40,D:35.90;X片好转率的费用-效果比(元/%)分别为,A:25.61,B:21.70,C:23.34,D:30.37。结论B组为较佳治疗方案,值得推广应用。