德国公立医院筹资与运行模式研究

德国公立医院筹资主要采取“双重补偿”机制,即投资成本和运营成本分开补偿.投资成本由政府以预算的形式拨付,运营成本由法定医疗保险公司按疾病诊断相关组付费支付.德国公立医院筹资与运行主要有以下4个特点：政府、行业协会和市场有各自明确的职责,相互协作实现医院的有效治理;公立医院的双重筹资模式与医院规划建立了紧密的问责关系;按疾病诊断相关组付费不仅是控费方式,也是定价机制引入的重要形式;由于实行“医药分开”,医院运行的主要成本是人员费用,药费占比较低.德国公立医院的筹资与运行模式对我国公立医院改革有4点启示：明确政府举办和管理公立医院的职责;联动规划和筹资,建立公立医院问责机制;改革公立医院的运行机制,扭转医院趋利行为;鼓励社会资本办医的同时加强行业监管.

Research on the Financing and Operation of Public Hospitals in Germany

The financing model of public hospitals in Germany is double-compensate model,which means the financing sources of investment cost and operation cost are different.Investment cost is appropriated in the form of budget,while operation cost is paid by DRGs.The experiences are that the responsibilities of government,association and market are clear to govern the public hospitals ; the double-compensate model has closely accountability relationships with hospital planning; DRGs is not only controlling cost methods,but also pricing mechanism; the main cost of public hospitals is staff cost,while the drug expenditure proportion is lower because of separation of clinic from pharmacy.The enlightenments from Germany are to clear the government responsibility of organized and management hospitals; link planning and financing to build accountability mechanisms ; reform the operation of public hospitals to reverse the profit mechanism ; encourage private hospital and enhance supervise.